2023-11-07T17:46:24-06:00 2022-12-31 010494526 Baker Newman & Noyes 650 Elm Street Suite 302 Manchester NH 03101 990 2022-01-01 010286541 Maine Dental Service Corporation MAIN 6032231000 PO Box 2002 Concord NH 033022002 Thomas Raffio President & CEO 6032231000 2023-11-07 1 Thomas Raffio 999009999 0 Connor Smart P02285543 6036262200 2023-11-07 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z Delta Dental Plan of Maine Thomas Raffio PO Box 2002 Concord NH 033022002 178886354 0 X www.nedelta.com X 1965 ME Provides programs of dental care 14 10 6 0 100000 0 0 0 147232528 163537312 932137 735449 0 0 148164665 164272761 600400 553900 125125793 138844633 1057128 1158470 0 0 0 16971735 19815567 143755056 160372570 4409609 3900191 78079521 75628828 7653369 7640155 70426152 67988673 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. 0 0 144587922 163437312 Maine Dental Service Corporation, Inc. 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. Maine Dental Service Corporation, Inc. processed approximately 792,700 claims in 2022. There are approximately 411,500 members in Maine included in the various plans. Customer's 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. 553900 553900 Maine Dental Service Corporation Inc. 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. 145141822 0 0 1 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 1 X 529 0 1 6 1 1 1 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Laurie Bienefeld 6032231000 One Delta Drive PO Box 2002 Concord NH 03302 X Jeffrey R Walawender DDS Chair & Director 3.00 X X 26027 0 0 Kyra Chadbourne DDS Chair & Director (part-year) 3.00 X X 16052 0 0 Bruce Nickerson CPA Treasurer & Director 3.00 X X 10975 0 0 Laura Oakes DMD Director 3.00 X 9980 0 0 Kristine Avery SPHR Director 3.00 X 9315 0 0 Kathy Reynolds Director 3.00 X 8815 0 0 Scott Normandeau Director 3.00 X 8815 0 0 Grace Odimayo DMD Director 3.00 X 8150 0 0 Craig Bradford Rand DDS Director 3.00 X 8150 0 0 Burton Rankie DDS Director 3.00 X 7315 0 0 Jayne Giles Vice Chair & Director 3.00 X X 7150 0 0 David Daigler CPA Director 3.00 X 6650 0 0 Katherin O'Grady Director 3.00 X 6650 0 0 Marcia Minter Director 3.00 X 4825 0 0 Michael Goldeberg Director (part-year) 3.00 X 4825 0 0 Melissa Haidu-Sylvia DDS Director 3.00 X 2660 0 0 Donald Oakes Director (part-year) 3.00 X 1000 0 0 Thomas Raffio DDPNH President & CEO 10.00 X 1018080 0 55849 Francis Boucher DDPNH Sr. Vice President 10.00 X 290816 0 56872 1456250 0 112721 0 0 1 1 Wyssta Services Inc PO Box 86 Stevens Point WI 54481 Contracted services 1034983 Cross Benefit Solutions 116 Community Drive Augusta ME 04330 Insurance broker commissions 456359 Combined Services LLC DBA csOne PO Box 1320 Concord NH 03301 Insurance broker commissions 340264 Maine Education Association 35 Community Drive Augusta ME 04330 Administrative fees 251093 Acadia Benefits 50 Portland Pier Suite 301 Portland ME 04101 Insurance broker commissions 228634 10 Admin service contract fees 524292 84462117 84462117 Premium revenue 524114 78975195 78975195 Management fees - CSLLC 524298 100000 100000 163537312 1231543 1231543 14117499 14613593 -496094 -496094 -496094 164272761 163437312 100000 735449 553900 553900 138844633 138844633 147354 147354 789583 789583 43535 43535 122269 122269 55729 55729 61600 61600 41995 41995 147500 147500 121484 121484 564800 564800 46281 46281 49029 49029 6673 6673 33693 33693 1025 1025 22698 22698 Administration - DDPNH 13052930 5743289 7309641 Brokers' commissions 3440798 3440798 Strategic initiatives 1838526 1838526 Dues and subscriptions 286896 286896 99639 99639 160372570 145141822 15230748 0 9263600 8748037 3457422 4038768 3689382 4663483 2756 15844 153729 152473 2281 1256 58425828 55008015 86272 19521 3098525 3063348 53455 70556 78079521 75628828 3531122 4036034 490000 433400 3632247 3170721 7653369 7640155 X 70426152 67988673 70426152 67988673 78079521 75628828 X 3900191 -6337670 0 X X 0 1 X 1 0 4000 4000 4000 1 House Republican Fund PO Box 5629 Augusta ME 04332 364860692 1000 House Democratic Campaign Committee PO Box 2021 Augusta ME 04338 222695883 1000 Senate Democratic Campaign Committee PO Box 2207 Augusta ME 04338 010478979 1000 Maine Senate Republican Majority PAC PO Box 1 Augusta ME 04332 263733192 1000 Part I-A, Line 1: Four campaign donations totaling $4,000 were made in Maine. 21115 21115 0 132614 131358 1256 1256 Unearned revenue 1491621 Advances - admin service contracts 1679100 3170721 X 80344656 -6337667 454544 -5883123 86227779 147500 77897481 78044981 164272760 82327589 0 82327589 147500 77897481 78044981 160372570 Part X, Line 2: The 2022 audited financial statements contain the following 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. 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 2d - Other Adjustments: Change in nonadmitted assets 454,544. Part XI, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 77,897,481. Change in nonadmitted assets Part XII, Line 4b - Other Adjustments: Dental claims paid under admin service contracts 77,897,481. 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 to conform with the statutory accounting practices of the National Association of Insurance Commissioners (NAIC), as prescribed or permitted by the Maine Bureau of Insurance. 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) 553900 0 General support to promote oral health 1 0 Part I, Line 2: Maine Dental Service Corporation (MDSC) 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. MDSC's total contributions to the Foundation in 2022 totaled $553,900. 0 0 0 0 0 0 0 0 0 Thomas Raffio DDPNH President & CEO 575726 0 404049 0 38305 0 32471 0 23378 0 1073929 0 0 0 Francis Boucher DDPNH Sr. Vice President 229118 0 61698 0 0 0 31165 0 25707 0 347688 0 0 0 Schedule J, Part II: Thomas Raffio, CEO, and Francis Boucher, Senior Vice President, received all of their compensation from Delta Dental Plan of New Hampshire, which is an unrelated organization per Schedule R definitions; while definitionally unrelated, Delta Dental Plan of New Hampshire does coordinate and work closely with the Maine Dental Service Corporation 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 Maine Dental Service Corporation 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. Laura Oakes DMD Director 1042284 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 Kyra Chadbourne DDS Chair & Director (part year) 445519 Please see above. 0 Craig Bradford Rand DDS Director 639394 Please see above. 0 Melissa Haidu-Sylvia DDS Director 293676 Please see above. 0 Burton Rankie DDS Director 210498 Please see above 0 Form 990, Part V, Line 2a The six employees included here are actually employed and paid by Delta Dental Plan of New Hampshire. These employees are assigned to provide sales and marketing services to Maine Dental Services Corporation. Maine Dental Services Corporation reimburses Delta Dental Plan of New Hampshire for these employees' payroll and employee benefit expenses. Form 990, Part VI, Section A, line 6 The membership of Maine Dental Service Corporation consists of the Board of Directors, all of the individuals covered under the Company's dental benefit plans, and the Maine dentists participating in the Company's dental networks which are used by the individuals covered under one of the Company's dental benefit plans. Form 990, Part VI, Section A, line 7a The Board of Trustees are elected at the Maine Dental Service Corporation's Annual Membership meeting, which requires a quorum of 25 members to conduct business. 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, 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. Form 990, Part IV, Line 23; and Part VII, Section A: Thomas Raffio, CEO, and Francis Boucher, 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 Maine Dental Service Corporation 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 the Maine Dental Service Corporation 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 Maine Dental Service Corporation. 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 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 2021 and 2022. 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.