2011-11-14T14:35:23-06:00 2010-12-31 BAKER NEWMAN & NOYES LLC 650 ELM STREET SUITE 302 MANCHESTER NH 03101 990 2010-01-01 010286541 MAINE DENTAL SERVICE CORPORATION MAIN 6032231000 PO BOX 2002 CONCORD NH 033022002 THOMAS RAFFIO 6032231000 2011-11-14 E DREW CHENEY 8002447444 2010 2016-02-24 21:20:13Z DELTA DENTAL PLAN OF MAINE THOMAS RAFFIO PO BOX 2002 CONCORD NH 033022002 86030355 0 X WWW.NEDELTA.COM X 1965 ME PROVIDES PROGRAMS OF DENTAL CARE 15 11 0 0 98446 0 0 0 75029888 79348867 1150196 945828 -4987 98446 76175097 80393141 144100 260300 64828944 67908059 631080 600925 0 0 0 9266107 9495323 74870231 78264607 1304866 2128534 34662773 37526646 7018385 6692018 27644388 30834628 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 70710762 79348867 PROGRAM SERVICES INCLUDE THE PROCESSING AND PAYMENT OF CLAIMS FOR DENTAL BENEFITS FOR VARIOUS ORGANIZATIONS. APPROXIMATELY 432,2000 CLAIMS WERE PROCESSED IN 2010. THERE ARE APPROXIMATELY 216,900 MEMBERS INCLUDED IN THE VARIOUS PLANS. 260300 260300 DONATION TO UNIVERSITY OF NEW ENGLAND TO BUILD A NEW DENTAL SCHOOL ($33,000).CONTRIBUTIONS TO NORTHEAST DELTA DENTAL FOUNDATION ($227,300). 70971062 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 0 0 0 0 0 0 0 0 0 0 1 192 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 15771 0 0 STEPHEN G MORSE DMD 3.00 X X 5122 0 0 BARRY C SALTZ DDS 3.00 X X 6258 0 0 BEVERLY ATTENBURG 3.00 X 4186 0 0 KEVIN C BAACK PHD 3.00 X 5831 0 0 DAVID L BAGDASARIAN DDS 3.00 X 4895 0 0 CHERYL BASCOMB 3.00 X 5363 0 0 MARYELLEN BEAULIEU EDD MPH RDH 3.00 X 4654 0 0 FRED BECHARD DED 3.00 X 468 0 0 CHARLES BROWN 3.00 X 7234 0 0 MICHAEL P GOLDBERG DMD 3.00 X 6395 0 0 CYNTHIA H HAMILTON 3.00 X 5413 0 0 CLIFFORD B LARLEE JR DMD 3.00 X 4895 0 0 MARTHA M LAWRENCE DDS 3.00 X 5363 0 0 MICHAEL W PARDUE 3.00 X 5363 0 0 DANIEL THAYER 3.00 X 3491 0 0 THOMAS RAFFIO - DDPNH 10.00 X 0 706067 149478 HELEN T BIGLIN - DDPNH 10.00 X 0 182420 31522 BENJAMIN E MARCUS ESQ 2.00 X 0 0 0 90702 888487 181000 0 0 1 1 TD INSURANCE INC PO BOX 406 OTS PORTLAND ME 04112 INSURANCE BROKER COMMISSIONS 271758 COMBINED SERVICES LLC 15 NORTH MAIN STREET SUITE 300 CONCORD NH 03301 INSURANCE BROKER COMMISSIONS 215338 THE HOLDEN AGENCY 1085 BRIGHTON AVENUE PORTLAND ME 04104 INSURANCE BROKER COMMISSIONS 212033 THE BAY AGENCY 520 OCEAN STREET SOUTH PORTLAND ME 04106 INSURANCE BROKER COMMISSIONS 143382 ACADIA BENEFITS INC 111 COMMERCIAL STREET PORTLAND ME 04101 INSURANCE BROKER COMMISSIONS 131019 7 PREMIUM REVENUE 524114 55215168 55215168 ADMIN SERVICE CONTRACT 524292 24133699 24133699 79348867 714254 714254 5868788 5637214 231574 231574 231574 MANAGEMENT FEE - CSLLC 561000 100000 100000 EQUITY LOSSES - NEW EN 524292 -1554 -1554 98446 80393141 79348867 98446 945828 260300 260300 67908059 67908059 90702 90702 394676 394676 21718 21718 63808 63808 30021 30021 17457 17457 88350 88350 98393 98393 18000 18000 422858 422858 62525 62525 55235 55235 32536 32536 36082 36082 245 245 17900 17900 21522 21522 ADMINISTRATION - DELTA 5694581 2748703 2945878 BROKERS' COMMISSIONS 2668995 2668995 DUES & SUBSCRIPTIONS 127594 127594 PROFESSIONAL RELATIONS 9669 9669 123381 54000 69381 78264607 70971062 7293545 0 2141195 2928762 3842308 3278960 2939924 3125601 6247 6754 200066 173272 24721 26794 24286952 26802005 1410112 1352030 11314 5740 34662773 37526646 2665233 2663876 1818300 1399100 2534852 2629042 7018385 6692018 X 27644388 30834628 27644388 30834628 34662773 37526646 X 2128534 1061706 X X 0 1 1 X 0 14667 11331 3336 122361 117611 4750 63038 44330 18708 26794 ACCRUED REFUNDS 238030 UNEARNED REVENUE 876912 ADVANCES - ADMIN SERV CONTRACTS 1514100 2629042 80393141 78264607 2128534 1061706 1061706 3190240 59045545 1061706 1061706 57983839 98393 22310909 22409302 80393141 55855305 0 55855305 98393 22310909 22409302 78264607 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PER THE AUDITED FINANCIAL STATEMENTS: MAINE DENTAL SERVICE CORPORATION (THE CORPORATION)'S MANAGEMENT HAS DETERMINED THAT THE CORPORATION HAS NOT TAKEN, NOR EXPECTS TO TAKE, ANY UNCERTAIN TAX POSITIONS IN ANY INCOME TAX RETURN. TAX YEARS AFTER DECEMBER 31, 2006 ARE OPEN FOR INTERNAL REVENUE SERVICE OR STATE EXAMINATION. PART XII, LINE 4B - OTHER ADJUSTMENTS: DENTAL CLAIMS PAID UNDER ADMIN SERVICE CONTRACTS 22,310,909. PART XIII, LINE 4B - OTHER ADJUSTMENTS: DENTAL CLAIMS PAID UNDER ADMIN SERVICE CONTRACTS 22,310,909. 1 UNIVERSITY OF NEW ENGLAND 11 HILLS BEACH ROAD BIDDEFORD ME 04005 010211810 501(C)(3) 33000 BUILDING A NEW DENTAL SCHOOL NORTHEAST DELTA DENTAL FOUNDATION ONE DELTA DRIVE PO BOX 2002 CONCORD NH 03302 020489150 501(C)(3) 227300 GENERAL SUPPORT TO PROMOTE ORAL HEALTH 2 0 OTHER INFORMATION: PART IV: 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 2010 TOTALED $227,300. 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 $33,000 RELATED TO THE CHANGE IN THE DISCOUNTED VALUE OF THE PLEDGE HAS BEEN RECORDED AS AN EXPENSE FOR THE YEAR ENDED DECEMBER 31, 2010. X X X X X 0 1 0 0 0 0 0 0 0 THOMAS RAFFIO - DDPNH 0 522204 0 125693 0 58170 0 120051 0 29427 0 855545 0 0 HELEN T BIGLIN - DDPNH 0 153461 0 11466 0 17493 0 9246 0 22276 0 213942 0 0 SUPPLEMENTAL INFORMATION PART III THOMAS RAFFIO, CEO, AND HELEN BIGLIN, 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. DAVID L BAGDASARIAN DDS DIRECTOR 506630 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 266870 0 BARRY C SALTZ DDS DIRECTOR 247576 0 CHARLES BROWN DDS DIRECTOR 107756 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 GAINS ON INVESTMENTS: 1,061,706. 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 2009 AND 2010.