Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
DELTA DENTAL OF NEW JERSEY INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1639 ROUTE 10 PO BOX 222
Suite
Room/suite
City or town, state or country, and ZIP + 4
PARSIPPANY, NJ070540222
D Employer identification number

22-1896118
E Telephone number

G Gross receipts $ 694,699,433
F Name and address of principal officer:
WALTER VANBRUNT
1639 ROUTE 10
PARSIPPANY,NJ070540222
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
deltadentalnj.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1969
M State of legal domicile: NJ
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROMOTE ORAL HEALTH TO THE GREATEST NUMBER OF PEOPLE BY PROVIDING ACCESSIBLE DENTAL BENEFIT PROGRAMS OF THE HIGHEST QUALITY, SERVICE AND VALUE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 339
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 568,365,246 586,736,484
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 10,307,155 9,541,554
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,551,813 1,623,175
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 580,224,214 597,901,213
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 900,000 1,900,000
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 513,306,702 529,982,972
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 29,637,280 31,492,351
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 27,082,387 26,681,511
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 570,926,369 590,056,834
19 Revenue less expenses. Subtract line 18 from line 12....... 9,297,845 7,844,379
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 292,503,594 296,891,583
21 Total liabilities (Part X, line 26)............. 82,742,516 72,710,526
22 Net assets or fund balances. Subtract line 21 from line 20..... 209,761,078 224,181,057
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: TO PROMOTE ORAL HEALTH TO THE GREATEST NUMBER OF PEOPLE BY PROVIDING ACCESSIBLE DENTAL BENEFIT PROGRAMS OF THE HIGHEST QUALITY, SERVICE AND VALUE. THE ORGANIZATION ALSO OFFERS AFFORDABLE DENTAL COVERAGE FOR THOSE INDIVIDUALS IN NEW JERSEY WITHOUT ACCESS TO A GROUP DENTAL PLAN. THE ORGANIZATION'S PLANS PROVIDE ACCESS TO A BROAD ARRAY OF DENTAL SERVICES THROUGH ITS VAST NETWORK OF PARTICIPATING DENTISTS. THE ORGANIZATION'S PLANS OFFER QUALITY COVERAGE OPTIONS AT COMPETITIVE RATES. FOR MORE THAN 40 YEARS, DELTA DENTAL OF NEW JERSEY HAS REACHED OUT TO SERVE THE PEOPLE OF NEW JERSEY AND MORE RECENTLY IN CONNECTICUT. IT IS OUR MISSION TO PROMOTE ORAL HEALTH TO THE GREATEST NUMBER OF PEOPLE BY PROVIDING ACCESSIBLE DENTAL BENEFIT PROGRAMS OF THE HIGHEST QUALITY, SERVICE, AND VALUE. IN 1986, WE FORMED THE DELTA DENTAL OF NEW JERSEY FOUNDATION, INC. TO AID IN CREATING ACCESS TO CARE FOR THE UNDER-INSURED AND UN-INSURED, AND SUPPORT DENTAL EDUCATION PROGRAMS FOR CHILDREN, AS WELL AS DENTAL ASSIST
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 582,151,512 including grants of $ 1,900,000 ) (Revenue $ 586,736,484 )
EXPENSES INCURRED IN PROMOTING ORAL HEALTH TO THE GREATEST NUMBER OF PEOPLE BY PROVIDING ACCESSIBLE DENTAL BENEFIT PROGRAMS OF THE HIGHEST QUALITY, SERVICE AND VALUE; PRIMARILY THROUGH CONTRACTS WITH INDEPENDENT DENTISTS TO MEMBER SUBSCRIBERS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet582,151,512
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A........................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
51,014
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
339
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBD
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
 
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletJAMES SULESKI1639 ROUTE 10PARSIPPANYNJ070540222 (973) 285-4029
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) RONALD DEBLINGER DMD........................................................................
CHAIRMAN - TRUSTEE
 20.0
.......................1.0 		X   X       131,514 0 1,588
(2) GERALD A SYDELL DDS........................................................................
VICE CHAIRMAN - TRUSTEE
 7.0
.......................1.0 		X   X       83,366 0 1,588
(3) ROBERT H BARNEY ESQ........................................................................
TRUSTEE (1/1-10/31)
 1.4
.......................   		X           38,520 0 1,324
(4) CARL CHAITYN DDS........................................................................
TRUSTEE
 2.2
.......................1.0 		X           39,245 0 1,588
(5) WILLIAM F FAHERTY JR........................................................................
TRUSTEE (1/1-8/31)
 1.3
.......................   		X           24,390 0 1,059
(6) WILLIAM FAULKNER........................................................................
TRUSTEE
 3.5
.......................   		X           43,417 2,000 940
(7) JEROME FELDMAN DDS........................................................................
TRUSTEE
 2.2
.......................   		X           39,394 0 1,156
(8) JOHN P HALL JR........................................................................
TRUSTEE
 4.1
.......................   		X           42,420 0 1,588
(9) HENRY F HENDERSON JR........................................................................
TRUSTEE
 3.5
.......................1.0 		X           44,605 0 1,588
(10) W THOMAS MARGETTS ESQ........................................................................
TRUSTEE
 3.2
.......................1.0 		X           43,184 0 1,588
(11) GEORGE C MCLAUGHLIN DMD........................................................................
TRUSTEE
 2.7
.......................1.0 		X           47,078 0 940
(12) GENE NAPOLIELLO DDS........................................................................
TRUSTEE
 2.2
.......................6.0 		X           40,948 0 1,588
(13) MORTON REINHART........................................................................
TRUSTEE
 3.5
.......................   		X           44,270 2,000 1,588
(14) DEBRA G SALMAN DDS........................................................................
TRUSTEE
 2.3
.......................   		X           38,608 0 2,702
(15) HOWARD A SCHWARTZ DDS........................................................................
TRUSTEE
 2.5
.......................   		X           38,158 0 940
(16) WALTER VANBRUNT........................................................................
PRESIDENT/CEO
 50.0
........................7 		    X       1,238,410 0 89,365
(17) JAMES SULESKI........................................................................
SENIOR VP/CFO
 50.0
........................4 		    X       395,754 0 90,554
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DOUGLAS G SANBORN ESQ........................................................................
SR VP/GENERAL COUNSEL
 50.0
........................4 		    X       631,610 0 90,065
(19) BRUCE SILVERMAN........................................................................
SENIOR VP/COO
 50.0
.......................   		    X       520,224 0 91,514
(20) STEVEN FLEISCHER........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       314,690 0 91,514
(21) DONALD SCOTT NAVARRO DDS........................................................................
VICE PRESIDENT
 50.0
........................6 		    X       281,750 0 88,585
(22) KATHLEEN FENNELL-BORGES........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       227,497 0 85,780
(23) THOMAS C KAHLER........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       227,445 0 86,674
(24) STEPHEN STOLL........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       223,245 0 86,733
(25) VINCENT FARINELLA........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       178,023 0 51,966
(26) DIANE BELLE........................................................................
VICE PRESIDENT
 44.0
.......................6.0 		    X       175,809 0 52,061
(27) ROBERT ZARCONE........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       157,935 0 70,261
(28) LORI ACKER........................................................................
VICE PRESIDENT
 50.0
.......................   		    X       152,494 0 46,482
(29) JOHN GUMKOWSKI........................................................................
DIRECTOR - MARKETING
 50.0
.......................   		        X   275,954 0 90,318
(30) KIM WHITE WAPELHORST........................................................................
ACCOUNT EXECUTIVE
 50.0
.......................   		        X   235,748 0 88,987
(31) DAVID ATHA........................................................................
DIRECTOR
 50.0
.......................   		        X   213,525 0 80,470
(32) ALLAN BERKIN........................................................................
ACCOUNT EXECUTIVE
 50.0
.......................   		        X   200,877 0 80,754
(33) DOREEN PILIGIAN........................................................................
DIRECTOR/ASST GENERAL COUNSEL
 50.0
.......................   		        X   162,657 0 47,028
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,552,764 4,000 1,430,876
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet44
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
DENTAL ASSOCIATES OF CONNECTICUT, 36 PADANARAM ROADDANBURYCT06811 DENTAL PROVIDER 1,892,834
ACCENTURE LLP, 1345 AVENUE OF THE AMERICASNEW YORKNY10105 CONSULTING 1,790,214
DECARE SYSTEMS IRELAND LTD, CURRANHEEN ROADCORK0EI SYSTEMS DEVELOPER 1,644,126
BROWN BROWN BENEFIT ADVISORS, 5 REGENT STREETLIVINGSTONNJ07039 BROKERAGE 1,456,783
HAMILTON DENTAL ASSOCIATES, 2501 KUSER ROADTRENTONNJ08691 DENTAL PROVIDER 1,339,968
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1,012
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a DENTAL BENEFITS COVERAGE REVENUE 524114 586,736,484 586,736,484    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 586,736,484
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 5,665,172     5,665,172
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,498,720  
b Less: rental expenses 2,184,454  
c Rental income or (loss) -685,734 0
d Net rental income or (loss).......MediumBullet -685,734     -685,734
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 98,490,148  
b Less: cost or other basis and sales expenses 94,613,766  
c Gain or (loss) 3,876,382  
d Net gain or (loss)..........MediumBullet 3,876,382     3,876,382
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a REINSURANCE REIMBURSEMENT 900099 2,290,094     2,290,094
b LEGAL SETTLEMENTS 900099 18,815     18,815
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 2,308,909
12 Total revenue. See Instructions......MediumBullet 597,901,213 586,736,484   11,164,729
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,900,000 1,900,000
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 529,982,972 529,982,972
5 Compensation of current officers, directors, trustees, and key employees .... 6,507,323 5,205,858 1,301,465 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 14,372,044 11,497,635 2,874,409  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,634,703 4,171,233 463,470  
9 Other employee benefits ....... 4,209,057 3,788,151 420,906  
10 Payroll taxes ........... 1,769,224 1,592,302 176,922  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 89,253 80,328 8,925  
c Accounting ........... 198,560 178,704 19,856  
d Lobbying ........... 88,882 79,994 8,888  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 4,176,415 3,758,773 417,642  
12 Advertising and promotion .... 646,157 581,541 64,616  
13 Office expenses ....... 5,203,373 4,683,036 520,337  
14 Information technology ...... 708,035 637,232 70,803  
15 Royalties .. 0      
16 Occupancy ........... 1,308,768 1,177,891 130,877  
17 Travel ............ 338,057 304,252 33,805  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 2,330,177 2,097,159 233,018  
23 Insurance .............. 624,896 562,406 62,490  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a BROKERAGE COMMISSIONS 9,051,830 8,146,647 905,183 0
b MEMBERSHIPS 667,074 600,367 66,707 0
c BANK SERVICE FEES 464,605 418,145 46,460 0
d REGULATORY FEES 404,980 364,482 40,498 0
e All other expenses 380,449 342,404 38,045  
25 Total functional expenses. Add lines 1 through 24e 590,056,834 582,151,512 7,905,322 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 10,269,230 1 9,718,445
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 40,986,562 4 40,996,489
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 1,646,014 9 2,123,715
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 37,757,489
b Less: accumulated depreciation ..... 10b 12,910,725 26,022,311 10c 24,846,764
11 Investments—publicly traded securities .......... 181,234,843 11 184,635,667
12 Investments—other securities. See Part IV, line 11 ..... 18,134,026 12 22,303,666
13 Investments—program-related. See Part IV, line 11 ..... 9,749,161 13 8,747,973
14 Intangible assets ............... 196,774 14 176,512
15 Other assets. See Part IV, line 11 ........... 4,264,673 15 3,342,352
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 292,503,594 16 296,891,583
Liabilities 17 Accounts payable and accrued expenses ......... 10,217,391 17 9,577,676
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 72,525,125 25 63,132,850
26 Total liabilities. Add lines 17 through 25......... 82,742,516 26 72,710,526
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..............   27  
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........ 25,000 30 25,000
31 Paid-in or capital surplus, or land, building or equipment fund ..... 218,568,952 31 226,413,332
32 Retained earnings, endowment, accumulated income, or other funds -8,832,874 32 -2,257,275
33 Total net assets or fund balances ........... 209,761,078 33 224,181,057
34 Total liabilities and net assets/fund balances ........ 292,503,594 34 296,891,583
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
597,901,213
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
590,056,834
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
7,844,379
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
209,761,078
5
Net unrealized gains (losses) on investments ...............
5
1,620,583
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
4,955,017
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
224,181,057
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number

22-1896118
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   10,060,407 10,060,407
b Buildings ................   7,597,676 452,488 7,145,188
c Leasehold improvements ............   1,310,329 752,726 557,603
d Equipment ................   18,326,361 11,303,886 7,022,475
e Other .................   462,716 401,625 61,091
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 24,846,764
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) EQUITY SECURITIES 		22,303,666 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 22,303,666
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
UNPAID CLAIMS 36,550,000
UNPAID CLAIMS ADJUSTMENT EXPENSES 2,349,000
DEPOSITS AND ADVANCES 5,098,220
ACCRUED PENSION COSTS 18,275,281
OTHER LIABILITIES 300,125
DUE TO AFFILIATES 445,935
SECURITY DEPOSITS 114,289


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 63,132,850
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 606,199,463
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 1,620,583
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 8,967,761
e Add lines 2a through 2d ..................... 2e 10,588,344
3 Subtract line 2e from line 1..................... 3 595,611,119
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b 2,290,094
c Add lines 4a and 4b....................... 4c 2,290,094
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 597,901,213
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 590,636,928
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 4,012,744
e Add lines 2a through 2d...................... 2e 4,012,744
3 Subtract line 2e from line 1..................... 3 586,624,184
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b 3,432,650
c Add lines 4a and 4b....................... 4c 3,432,650
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 590,056,834
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
TEXT OF ASC 740 AUDITED FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE TAXPAYER AND ITS AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY, AND ISSUED A CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES BY ENTITY. THE FIN 48 (ASC 740) FOOTNOTE BELOW IS FROM THE ORGANIZATION'S 2012 CONSOLIDATED AUDITED FINANCIAL STATEMENTS: THE PLAN FOLLOWS THE RECOGNITION AND DISCLOSURE PROVISIONS OF THE ACCOUNTING STANDARD RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. UNDER THIS STANDARD, TAX POSITIONS ARE EVALUATED FOR RECOGNITION USING A MORE-LIKELY-THAN-NOT THRESHOLD, AND THOSE TAX POSITIONS REQUIRING RECOGNITION ARE MEASURED AT THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE SETTLEMENT WITH A TAXING AUTHORITY THAT HAS FULL KNOWLEDGE OF ALL RELEVANT INFORMATION. THE PLAN HAS EVALUATED THE LIKELIHOOD OF THEIR TAX POSITIONS BEING CHALLENGED AS REMOTE AND, ACCORDINGLY HAS NOT INCLUDED ANY INCOME TAX PROVISIONS, INCLUDING INTEREST AND PENALTIES, IN THE FINANCIAL STATEMENTS RELATED TO POTENTIAL VIOLATIONS. THE PLAN HAS NO OPEN YEARS PRIOR TO 2009.
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN SCHEDULE D, PART XI, LINE 2D OTHER AMOUNTS INCLUDED ON AUDITED FINANCIAL STATEMENTS BUT NOT ON FORM 990: -INTERCOMPANY RENT PAID TO DISREGARDED ENTITY - $1,828,290; -EXPENSES OF DISREGARDED ENTITY - $2,184,454; -NET CHANGE RELATED TO ACCRUED PENSION - $4,955,017.
RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN SCHEDULE D, PART XII, LINE 4B OTHER AMOUNTS INCLUDED ON FORM 990 BUT NOT ON AUDITED FINANCIAL STATEMENTS: -REINSURANCE REIMBURSEMENT - $2,290,094;
RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN SCHEDULE D, PART XII, LINE 2D OTHER AMOUNTS INCLUDED ON AUDITED FINANCIAL STATEMENTS BUT NOT ON FORM 990: -INTERCOMPANY RENT PAID TO DISREGARDED ENTITY - $1,828,290; -EXPENSES OF DISREGARDED ENTITY - $2,184,454.
RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN SCHEDULE D, PART XII, LINE 4B OTHER AMOUNTS INCLUDED ON AUDITED FINANCIAL STATEMENTS BUT NOT ON FORM 990: -REINSURANCE REIMBURSEMENT - $2,290,094; -NET INCOME OF DISREGARDED ENTITY - $1,142,556.
Schedule D (Form 990) 2012

Additional Data


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Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number
22-1896118
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) DELTA DENTAL OF NEW JERSEY FOUNDATION INC
1639 ROUTE 10
PARSIPPANY,NJ07054 		22-2764745 501(c)(3) 1,900,000       PROGRAM SUPPORT






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
GRANT FUND MONITORING SCHEDULE I, PART I, QUESTION 2 DELTA DENTAL OF NEW JERSEY FOUNDATION, INC. ("FOUNDATION"); A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, IS FUNDED SOLELY BY DELTA DENTAL OF NEW JERSEY, INC. THE MONIES DISBURSED BY THE FOUNDATION ARE BASED ON GRANT REQUESTS WHICH ARE REVIEWED AND APPROVED BY THE FOUNDATION BOARD OF TRUSTEES BASED ON NEED. IN THE CASE OF LARGE GRANT REQUESTS THAT MAY SPAN MULTIPLE YEARS, THE DISBURSEMENT MAY BE MADE FROM THE ORGANIZATION AND NOT ITS RELATED FOUNDATION. THE ORGANIZATION'S BOARD OF TRUSTEES' APPROVAL IS REQUIRED FOR THIS TYPE OF COMMITMENT. PROGRESS ON GRANTS OF THIS NATURE IS MONITORED BY THE ORGANIZATION WITH UPDATES PROVIDED TO THE BOARD OF TRUSTEES.
Schedule I (Form 990) 2012


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number

22-1896118
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)WALTER VANBRUNTPRESIDENT/CEO (i)
(ii)		 508,434
0 		256,763
0 		473,213
0 		52,750
0 		36,615
0 		1,327,775
0 		0
0
(2)JAMES SULESKISENIOR VP/CFO (i)
(ii)		 237,047
0 		87,556
0 		71,151
0 		52,750
0 		37,804
0 		486,308
0 		0
0
(3)DOUGLAS G SANBORN ESQSR VP/GENERAL COUNSEL (i)
(ii)		 313,217
0 		129,880
0 		188,513
0 		52,750
0 		37,315
0 		721,675
0 		0
0
(4)BRUCE SILVERMANSENIOR VP/COO (i)
(ii)		 294,571
0 		102,214
0 		123,439
0 		52,750
0 		38,764
0 		611,738
0 		0
0
(5)STEVEN FLEISCHERVICE PRESIDENT (i)
(ii)		 235,819
0 		70,363
0 		8,508
0 		52,750
0 		38,764
0 		406,204
0 		0
0
(6)DONALD SCOTT NAVARRO DDSVICE PRESIDENT (i)
(ii)		 199,154
0 		63,924
0 		18,672
0 		52,750
0 		35,835
0 		370,335
0 		0
0
(7)KATHLEEN FENNELL-BORGESVICE PRESIDENT (i)
(ii)		 164,383
0 		51,995
0 		11,119
0 		48,601
0 		37,179
0 		313,277
0 		0
0
(8)THOMAS C KAHLERVICE PRESIDENT (i)
(ii)		 157,646
0 		52,010
0 		17,789
0 		48,610
0 		38,064
0 		314,119
0 		0
0
(9)STEPHEN STOLLVICE PRESIDENT (i)
(ii)		 166,009
0 		51,905
0 		5,331
0 		47,969
0 		38,764
0 		309,978
0 		0
0
(10)VINCENT FARINELLAVICE PRESIDENT (i)
(ii)		 134,068
0 		40,624
0 		3,331
0 		37,964
0 		14,002
0 		229,989
0 		0
0
(11)DIANE BELLEVICE PRESIDENT (i)
(ii)		 134,615
0 		40,084
0 		1,110
0 		37,459
0 		14,602
0 		227,870
0 		0
0
(12)ROBERT ZARCONEVICE PRESIDENT (i)
(ii)		 139,223
0 		16,881
0 		1,831
0 		33,496
0 		36,765
0 		228,196
0 		0
0
(13)LORI ACKERVICE PRESIDENT (i)
(ii)		 128,368
0 		22,910
0 		1,216
0 		32,580
0 		13,902
0 		198,976
0 		0
0
(14)JOHN GUMKOWSKIDIRECTOR - MARKETING (i)
(ii)		 198,808
0 		72,774
0 		4,372
0 		52,553
0 		37,765
0 		366,272
0 		0
0
(15)KIM WHITE WAPELHORSTACCOUNT EXECUTIVE (i)
(ii)		 177,193
0 		56,398
0 		2,157
0 		50,222
0 		38,765
0 		324,735
0 		0
0
(16)DAVID ATHADIRECTOR (i)
(ii)		 173,743
0 		22,951
0 		16,831
0 		45,155
0 		35,315
0 		293,995
0 		0
0
(17)ALLAN BERKINACCOUNT EXECUTIVE (i)
(ii)		 176,735
0 		20,604
0 		3,538
0 		42,470
0 		38,284
0 		281,631
0 		0
0
(18)DOREEN PILIGIANDIRECTOR/ASST GENERAL COUNSEL (i)
(ii)		 145,256
  		17,070
0 		331
0 		34,426
0 		12,602
0 		209,685
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTIONS 1A AND 1B THE ORGANIZATION'S PRESIDENT/CEO TRAVELS FIRST CLASS ON BUSINESS RELATED FLIGHTS EXCEEDING THREE HOURS TO ATTEND ORGANIZATION RELATED WORK EVENTS. THIS PROVIDES THE PRESIDENT/CEO THE ABILITY TO WORK ON ORGANIZATIONAL MATTERS DURING TRAVEL. ON OCCASION, TRAVEL EXPENSES FOR SPOUSES OF SENIOR OFFICERS ARE PAID BY THE ORGANIZATION WHEN RELATED TO A COMPANY EVENT (DELTA DENTAL PLANS ASSOCIATION ANNUAL MEETING, ETC). THE EXCESS COST OVER STANDARD RELATED TO THE 1ST CLASS AND SPOUSAL TRAVEL WAS NOT INCLUDED IN THE RESPECTIVE INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. THE ORGANIZATION REIMBURSES ITS PRESIDENT/CEO, WALTER VANBRUNT, FOR A MEMBERSHIP IN A COUNTRY CLUB. DURING 2012, MR. VANBRUNT'S 2012 FORM W-2, BOX 5, MEDICARE WAGES, INCLUDES $5,341 OF TAXABLE COMPENSATION WHICH RELATES TO HIS PERSONAL USAGE OF THE COUNTRY CLUB. THE ORGANIZATION PAID FOR FINANCIAL/TAX PLANNING SERVICES FOR CERTAIN EMPLOYEES. THE FINANCIAL/TAX PLANNING SERVICES AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S RESPECTIVE 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: WALTER VANBRUNT, $400; BRUCE SILVERMAN, $470; STEVEN FLEISCHER, $625; DAVID SCOTT NAVARRO, D.D.S., $750; THOMAS C. KAHLER, $170 KATHLEEN FENNELL-BORGES, $450 AND DIANE BELLE, $160. THE ORGANIZATION'S PRESIDENT/CEO, WALTER VANBRUNT'S 2012 FORM W-2, BOX 5, INCLUDES A TAX GROSS-UP PAYMENT OF $11,417, RELATED TO HIS FORM W-2, BOX 5, TAXABLE COMPENSATION RESULTING FROM THE PERSONAL USAGE OF AN AUTO, COUNTRY CLUB DUES AND FINANCIAL/TAX PLANNING SERVICES. THE ORGANIZATION'S SENIOR VICE PRESIDENT/OPERATIONS, BRUCE SILVERMAN'S 2012 FORM W-2, BOX 5, INCLUDES A TAX GROSS-UP PAYMENT OF $5,464, RELATED TO HIS FORM W-2, BOX 5, TAXABLE COMPENSATION RESULTING FROM FINANCIAL/TAX PLANNING SERVICES AND AUTO ALLOWANCE. THE ORGANIZATION'S SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER, JAMES SULESKI'S 2012 FORM W-2, BOX 5, INCLUDES A TAX GROSS-UP PAYMENT OF $3,896, RELATED TO HIS FORM W-2, BOX 5, TAXABLE COMPENSATION RESULTING FROM AN AUTO ALLOWANCE. THE ORGANIZATION'S SENIOR VICE PRESIDENT/GENERAL COUNSEL, DOUGLAS G. SANBORN, ESQ.'S 2012 FORM W-2, BOX 5, INCLUDES A TAX GROSS-UP PAYMENT OF $5,153, RELATED TO HIS FORM W-2, BOX 5, TAXABLE COMPENSATION RESULTING FROM THE PERSONAL USAGE OF AN AUTO. IN ADDITION, CERTAIN BOARD OF TRUSTEE MEMBERS 2012 FORM 1099-MISC INCLUDES TAX GROSS-UP PAYMENTS RELATED TO COMPENSATION PAID TO THEM FOR PERSONAL USAGE OF AN AUTO AND/OR FINANCIAL/TAX PLANNING SERVICES.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 4B THE AMOUNTS REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDE PARTICIPATION IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") BECAUSE THE AMOUNTS ARE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: WALTER VANBRUNT, $429,296; BRUCE SILVERMAN, $101,174; JAMES SULESKI, $43,636 AND DOUGLAS G. SANBORN, ESQ., $159,041. PLEASE NOTE THAT THE AMOUNTS REFLECTED INCLUDE A GROSS UP FOR 50% OF THE TAX LIABILITY WITH RESPECT TO THE SERP PAYMENTS.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 7 AND CORE FORM, PART VII CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2012 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2012 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
Schedule J (Form 990) 2012

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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number

22-1896118
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) CLIFTON ENDODONTICS ASSOCIATION COMPANY-DEBLINGER,TRUSTEE 182,311 DENTAL CARE PROVIDER   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV RONALD DEBLINGER, DMD, IS THE CHAIRMAN OF THE BOARD OF TRUSTEES OF THE ORGANIZATION. THE ORGANIZATION UTILIZED THE SERVICES OF HIS DENTAL PRACTICE, CLIFTON ENDODONTICS ASSOCIATION, DURING 2012. TOTAL FEES PAID TO CLIFTON ENDODONTICS ASSOCIATION DURING 2012 WERE $182,311. SERVICES WERE PAID BASED ON THE SAME FEE CRITERIA AS APPLY TO SIMILARLY SITUATED DENTISTS THROUGHOUT THE CORPORATION'S DENTAL NETWORK.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number

22-1896118
Identifier Return Reference Explanation
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTION 3 The organization retained the services of an outside property manager TO MANAGE THE DAY TO DAY ACTIVITIES AND OPERATIONS OF its single member LIMITED LIABILITY COMPANY; 1639 Real Estate, LLC.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 MEMBERS OF THE ORGANIZATION SERVE AS THE TRUSTEES OF THE ORGANIZATION AND EXISTING MEMBERS VOTE TO ELECT NEW MEMBERS OF THE ORGANIZATION.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11B THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF ITS GOVERNING BODY (ITS BOARD OF TRUSTEES) PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. AS PART OF THE TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED WITHUMSMITH+BROWN, PC, A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION, TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S SENIOR MANAGEMENT AND VARIOUS OTHER INDIVIDUALS OF THE ORGANIZATION TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS FOR THEIR REVIEW. THE ORGANIZATION'S SENIOR MANAGEMENT AND OTHER INDIVIDUALS REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S SENIOR MANAGEMENT AND VARIOUS OTHER INDIVIDUALS FOR FINAL REVIEW AND APPROVAL PRIOR TO PROVIDING IT TO EACH VOTING MEMBER OF ITS GOVERNING BODY.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 12 THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS, SENIOR MANAGEMENT AND OTHER KEY PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO MEMBERS OF THE ORGANIZATION'S SENIOR MANAGEMENT. SENIOR MANAGEMENT PROVIDES THE COMPLETED QUESTIONNAIRES TO THE ORGANIZATION'S AUDIT COMMITTEE FOR ITS REVIEW AND DISCUSSION WITH RESPECT TO CONFLICTS AND ANY ASSOCIATED MITIGATING BEHAVIOR. THE AUDIT COMMITTEE THEN REPORTS TO THE ORGANIZATION'S BOARD OF TRUSTEES.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 14 THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF ADOPTING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. THE ORGANIZATION CURRENTLY FOLLOWS STATE AND INTERNAL REVENUE SERVICE RULES AND REGULATIONS WITH RESPECT TO DOCUMENT RETENTION AND DESTRUCTION POLICIES AND PROCEDURES.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 15 THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE AND HUMAN RESOURCES COMMITTEE ("COMMITTEE"). THE BOARD HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT TEAM, WHICH INCLUDES THE PRESIDENT/CHIEF EXECUTIVE OFFICER, SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER, SENIOR VICE PRESIDENT/GENERAL COUNSEL AND THE SENIOR VICE PRESIDENT/CHIEF OPERATING OFFICER. THE "TOTAL COMPENSATION" OF THE INDIVIDUALS REVIEWED INCLUDES BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THIS REVIEW IS DONE ON AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. COMPENSATION FOR THE SENIOR VICE PRESIDENT & GENERAL COUNSEL, SENIOR VICE PRESIDENT & CHIEF FINANCIAL OFFICER AND SENIOR VICE PRESIDENT/CHIEF OPERATING OFFICER, WHO REPRESENT SENIOR MANAGEMENT OF THE ORGANIZATION, IS REVIEWED AND APPROVED BY THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF TRUSTEES ANNUALLY, AND IS EFFECTIVE EACH JANUARY 1ST. THE PRESIDENT & CHIEF EXECUTIVE OFFICER'S PERFORMANCE IS REVIEWED BY THE EXECUTIVE AND HUMAN RESOURCES COMMITTEE OF THE BOARD OF TRUSTEES, WHICH PROVIDES INPUT TO THE FULL BOARD. COMPENSATION OF THE PRESIDENT & CHIEF EXECUTIVE OFFICER IS DETERMINED AND APPROVED BY THE BOARD OF TRUSTEES.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION C; QUESTION 19 THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY.
OTHER CHANGES IN NET ASSETS CORE FORM, PART XI; QUESTION 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDES: - NET CHANGE ARISING DURING THE PERIOD RELATED TO ACCRUED PENSION; $4,955,017.
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF THE TAXPAYER AND ITS AFFILIATES FOR THE YEARS ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2011; RESPECTIVELY, AND ISSUED A CONSOLIDATED FINANCIAL STATEMENT WITH CONSOLIDATING SCHEDULES BY ENTITY. AN UNQUALIFIED OPINION WAS ISSUED BY THE INDEPENDENT CPA FIRM EACH YEAR. THE ORGANIZATION'S AUDIT COMMITEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
DELTA DENTAL OF NEW JERSEY INC
 
Employer identification number

22-1896118
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) DELTA DENTAL OF NEW JERSEY PAC INC
1639 ROUTE 10
PARSIPPANY,NJ07054
22-3754874 		RELATED NJ 11,950 30,309 NA
 
(2) 1639 REAL ESTATE LLC
1639 ROUTE 10
PARSIPPANY,NJ07054
 RELATED NJ 3,327,010 23,117,957 DDNJ
 








Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) DELTA DENTAL OF NJ FOUNDATION INC

1639 ROUTE 10

PARSIPPANY,NJ07054
22-2764745 		PUBLIC SRVC. NJ 501(C)(3) 509(A)(3) DDNJ
 
Yes
 












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) DDPNJ CORPORATION

1639 ROUTE 10
PARSIPPANY,NJ07054
22-3085009 		HOLDING COMPANY NJ DDNJ
  		C CORP. 0 7,995,376 100.000 % Yes  
(2) FLAGSHIP HEALTH SYSTEMS INC

1639 ROUTE 10
PARSIPPANY,NJ07054
22-2671069 		DENTAL PLAN ORG. NJ DDPNJ
  		C CORP.       Yes  
(3) DENTAL REINSURANCE COMPANY LTD

44 CHURCH STREET
HAMILTON    
BD
98-0160853 		FOREIGN REINS. BD DDPNJ
  		C CORP.       Yes  








Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) DELTA DENTAL OF NJ FOUNDATION INC

 B 1,900,000 COST
(2) FLAGSHIP HEALTH SYSTEMS INC

 L 841,484 COST




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: