2024-11-12T13:08:17-06:00 2023-12-31 540504608 BROWN EDWARDS & COMPANY LLP 3906 ELECTRIC ROAD ROANOKE VA 24018 990 2023-01-01 540844477 DELTA DENTAL OF VIRGINIA DELT 5409898000 5415 AIRPORT ROAD ROANOKE VA 240121303 R JAMES BARKER SECRETARY/TREASURER 5409898000 2024-11-11 1 0 PATRICK PITTMAN P00587461 5403450936 2024-11-11 2023 2024-10-15 13:58:12Z X R JAMES BARKER 5415 AIRPORT ROAD ROANOKE VA 240121303 815401111 0 X WWW.DELTADENTALVA.COM X 1964 VA IMPROVE THE PUBLIC'S ORAL HEALTH. 11 10 74 0 0 0 0 0 762952163 801789932 3101345 5694351 -72578 25159 765980930 807509442 0 2143539 0 0 11048545 11708780 0 0 0 739034875 777909296 750083420 791761615 15897510 15747827 192504352 198461939 71042487 69020399 121461865 129441540 ADVANCE THE PUBLIC'S ORAL HEALTH BY PROVIDING QUALITY DENTAL BENEFITS AT AFFORDABLE COST. 0 0 700509124 0 801789932 GROUP AND INDIVIDUAL PREPAID DENTAL CARE WAS PROVIDED FOR SUBSCRIBERS AND FAMILIES IF ENROLLED. 2143539 2143539 DELTA DENTAL OF VIRGINIA SUPPORTS ITS MISSION BY CONTRIBUTING TO THE DELTA DENTAL OF VIRGINIA FOUNDATION. THE FOUNDATION WORKS TO IMPROVE THE ORAL HEALTH OF ALL VIRGINIANS THROUGH FINANCIAL SUPPORT AND RESEARCH, EDUCATION INITIATIVES, AND PROGRAMS THAT PROVIDE ACCESS TO THE UNDERSERVED. THE COMPANY ALSO SUPPORTS OTHER NON-PROFIT ORGANIZATIONS WITHIN THE COMMUNITY. 702652663 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 61818 0 1 74 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X R JAMES BARKER 5409898000 5415 AIRPORT ROAD ROANOKE VA 24012 MS LAURA W THOMAS CHAIRMAN OF THE BOARD 3.00 5.00 X X 58250 0 0 MR THOMAS R BYRD DIRECTOR 3.00 5.00 X 0 59000 0 MR DANIEL E DRAPER DIRECTOR 3.00 0.00 X 36866 0 0 MS JACQUELYN E STONE DIRECTOR 4.00 0.00 X 32625 0 0 MR DOUGLAS JUANARENA DIRECTOR 1.00 3.00 X 0 34500 0 DR LEZLEY P MCILVEEN DIRECTOR 4.00 1.00 X 45045 0 0 MS SHARON M MUSCARELLA DIRECTOR 3.00 0.00 X 35168 0 0 DR A CAROLE PRATT DIRECTOR 3.00 1.00 X 35736 0 0 DR MCKINLEY L PRICE DIRECTOR 4.00 1.00 X 33375 0 0 MS PAMELA S SCHUTZ DIRECTOR 1.00 2.00 X 0 37625 0 MR FRANK L LUCIA PRESIDENT & CEO 1.00 41.00 X X 0 2041318 96859 MR R JAMES BARKER SECRETARY/TREASURER 0.00 40.00 X 0 803832 83660 MR DAVID NOTARI SENIOR VP & COO 40.00 0.00 X 829260 0 91812 MR BRADLEY KNOPF VICE PRESIDENT 40.00 0.00 X 511055 0 62783 MR CHRISTOPHER PYLE VICE PRESIDENT 40.00 0.00 X 481080 0 54313 MR JASON REYNOLDS STAFF 40.00 0.00 X 260941 0 43928 MS MELISSA KIRSH STAFF 40.00 0.00 X 393725 0 69015 MR BRIAN KRAINER STAFF 40.00 0.00 X 343008 0 65887 MR MATTHEW MACDONALD STAFF 40.00 0.00 X 338579 0 71724 MR JOHN WILSON STAFF 40.00 0.00 X 250521 0 39707 3685234 2976275 679688 18 0 1 0 WYSSTA SERVICES INC PO BOX 86 STEVENS POINT WI 54481 TPA SERVICES 6851217 ENCARA INC 4515 AIRPORT ROAD ROANOKE VA 24012 MARKETING SERVICES 2633271 NEMER FIEGER & ASSOCIATES INC 6250 EXCELSIOR BLVD MINNEAPOLIS MN 55416 ADVERTISING SERVICES 395000 BLACKROCK INVESTMENT MANAGEMENT LLC PO BOX 978604 DALLAS TX 753978604 INVESTMENT MANAGEMENT 269378 ABM INDUSTRY GROUPS LLC PO BOX 74008829 CHICAGO IL 606748829 JANITORIAL SERVICES 109407 5 ASC CONTRACTS 524114 478741775 478741775 RISK PREMIUMS 524114 295792169 295792169 ASC FEES EARNED 524114 27255988 27255988 801789932 4973877 4973877 879119 853960 25159 25159 25159 7758183 7037709 720474 720474 720474 807509442 801789932 0 5719510 2143539 2143539 2487888 2487888 7067619 7067619 791402 791402 836565 836565 525306 525306 28855465 28855465 29741 29741 82360 82360 297360 297360 29239399 29239399 997944 997944 395440 395440 508948 508948 275118 275118 48403 48403 DENTAL CLAIMS 700509124 700509124 BROKERAGE COMMISSIONS A 8367634 8367634 STATE PREMIUM TAXES AND 6221176 6221176 BUSINESS DUES AND ASSOC 887474 887474 1193710 1193710 791761615 702652663 89108952 0 449 449 38690278 44297672 51067655 45008635 372030 360989 15796583 6336066 9720399 9460517 89103421 96275500 2100 2100 3548020 3056077 192504352 198461939 20284562 17493187 50757925 51527212 71042487 69020399 X 0 0 0 0 121461865 129441540 121461865 129441540 192504352 198461939 X 15747827 4231848 -12000000 X X 0 1 X 1 0 109950 109950 1 DELEGATE DON SCOTT 355 CRAWFORD STREET SUITE 704 PORTSMOUTH VA 23704 500 MCDOUGLE FOR VIRGINIA 5004 MOUNMENT AVE STE 100B RICHMOND VA 23230 500 KATHY BYRON HOUSE OF DELEGATES PO BOX 900 FOREST VA 24551 1000 CHARNIELE HERRING PO BOX 11779 ALEXANDRIA VA 22312 250 LAMONT BAGBY PO BOX 396 RICHMOND VA 23218 500 COMMONWEALTH FUND 1021 EAST CARY ST STE 1275 RICHMOND VA 23219 1000 MAMIE LOCKE PO BOX 9048 HAMPTON VA 23670 200 LUKE TORIAN 4222 FORTUNA CENTER PLAZA STE 659 DUMPHRIES VA 22025 250 HOUSE REPUBLICAN CAMPAIGN COMMITTEE PO BOX 71596 HENRICO VA 23255 13000 MICHAEL WEBERT FOR DELEGATE PO BOX 469 WARRENTON VA 20188 3000 KILGORE FOR DELEGATE PO BOX 669 GATE CITY VA 24251 3000 ADAM EBBIN FOR VIRGINIA SENATE PO BOX 26415 ALEXANDRIA VA 22313 250 SUROVELL FOR STATE SENATE PO BOX 289 MOUNT VERNON VA 22121 3000 DICK SASLAW PO BOX 1472 RICHMOND VA 23218 1000 VIRGINIA LEGISLATIVE BLACK CAUCUS PO BOX 15512 RICHMOND VA 23227 250 REPUBLICAN COMMONWEALTH LEADERSHIP PAC PO BOX 71596 RICHMOND VA 23255 500 ELLEN CAMPBELL FOR DELEGATE PO BOX 406 RICHMOND VA 23218 250 BARKER FOR SENATE PO BOX 10527 ALEXANDRIA VA 22310 1500 RYAN MCDOUGLE FOR SENATE PO BOX 187 MECHANICVILLE VA 23111 2500 SUETTERLEIN FOR SENATE PO BOX 20237 ROANOKE VA 24018 750 THE COMMONWEALTH VICTORY FUND 1021 EAST CARY ST STE 1275 RICHMOND VA 23219 7500 ELECT CHRIS HEAD PO BOX 19130 ROANOKE VA 24019 1500 SULLIVAN FOR DELEGATE PO BOX 50753 ARLINGTON VA 22205 2500 WILT FOR DELEGATE PO BOX 1425 HARRISONBURG VA 22803 1500 MCNAMARA FOR DELEGATE PO BOX 21094 ROANOKE VA 24018 2000 FRIENDS OF AMANDA BATTEN PO BOX 194 NORGE VA 23127 1500 FRIENDS OF CHRIS OBENSHAIN PO BOX 10041 BLACKSBURG VA 24060 250 FRIENDS OF DR TODD PILLION 851 FRENCH MOORE JR BLVD ABINGTON VA 24210 1000 FRIENDS OF LEE WARE 9912 HOLLAND MEADOWS COURT FREDRICKSBURG VA 22408 1500 DEEDS FOR STATE SENATE PO BOX 5462 CHARLOTTESVILLE VA 22905 1500 MARSHALL FOR DELEGATE PO BOX 439 DANVILLE VA 24543 1500 ORROCK FOR DELEGATE PO BOX 458 THORNBURG VA 22565 2000 LUCAS FOR SENATE PO BOX 700 PORTSMOUTH VA 23705 1500 SICKLES FOR DELEGATE PO BOX 10628 ALEXANDRIA VA 22310 1500 PRICE FOR DELEGATE PO BOX 196 NEWPORT NEWS VA 23607 1500 HAYES FOR DELEGATE 732 EDEN WAY N SUITE 183 CHESAPEAKE VA 23320 1500 MCGUIRE FOR DELEGATE 11375 NUCKOLS RD 156 GLEN ALLEN VA 23059 250 VIRGINIA SENATE REPUBLICAN CAUCUS PO BOX 1697 WILLIAMSBURG VA 23187 3500 FRIENDS OF MARK OBENSHAIN PO BOX 555 HARRISONBURG VA 22803 2500 FRIENDS OF DAVID BULOVA PO BOX 106 FAIRFAX STATION VA 22039 500 FRIENDS OF MARCUS SIMON PO BOX 958 FALLS CHURCH VA 22040 1250 KARRIE DELANEY FOR DELEGATE PO BOX 230542 CENTREVILLE VA 20120 1000 KRIZEK FOR DELEGATE 2201 WHITEOAKS DRIVE ALEXANDRIA VA 22306 1000 LEFTWICH FOR DELEGATE 308 CEDAR LAKES DRIVE 3RD FL CHESAPEAKE VA 23322 1000 LOPEZ FOR DELEGATE PO BOX 40366 ARLINGTON VA 22204 1500 REID FOR DELEGATE PO BOX 4132 ASHBURN VA 20148 500 FRIENDS OF LUKE TORIAN 4222 FORTUNA CENTER PLAZA STE 659 DUMPHRIES VA 22025 1500 LOCKE FOR SENATE PO BOX 9048 HAMPTON VA 23670 3500 FRIENDS OF MONTY MASON PO BOX 232 WILLIAMSBURG VA 23187 1500 MCPIKE FOR SENATE PO BOX 2819 WOODBRIDGE VA 22195 1500 FRIENDS OF DON SCOTT 355 CRAWFORD STREET SUITE 704 PORTSMOUTH VA 23704 5000 J WARD FOR DELEGATE PO BOX 7310 HAMPTON VA 23666 1250 FRIENDS OF SIOBHAN DUNNVANT PO BOX 70849 HENRICO VA 23255 1000 RICHARD STUART FOR SENATE 114 POLK STREET MONTROSS VA 22406 1000 FRIENDS OF LES ADAMS PO BOX K CHATHAM VA 24531 1500 TERRY L AUSTIN FOR HOUSE DELEGATE PO BOX 398 BUCHANAN VA 24066 1500 FRIENDS OF PATRICK HOPE PO BOX 3148 ARLINGTON VA 22203 1000 FRIENDS OF CHARNIELE HERRING PO BOX 11779 ALEXANDRIA VA 22312 1000 HELMER FOR VIRGINIA PO BOX 7267 FAIRFAX STATION VA 22039 500 RUFF FOR SENATE PO BOX 332 CLARKSVILLE VA 23927 1500 FRIENDS OF GLEN STURTEVANT PO BOX 71596 HENRICO VA 23255 1000 FRIENDS OF BARRY D KNIGHT 1852 MILL LANDING ROAD VIRGINIA BEACH VA 23457 1500 HOPE FOR VIRGINIA PO BOX 3148 ARLINGTON VA 22203 1000 VIRGINIA LEGISLATIVE BLACK CAUCUS PO BOX 15512 RICHMOND VA 23227 1000 RASOUL FOR DELEGATE 1417 PETERS CREEK ROAD NW ROANOKE VA 24017 1000 O'QUINN FOR DELEGATE PO BOX 16325 BRISTOL VA 24209 2500 MARSDEN FOR SENATE PO BOX 10889 BURKE VA 22009 2500 1291059 1963736 3254795 8751324 806697 3489896 6068125 1494083 1454130 39953 136151 1246049 1284556 97644 107484 107484 0 9460517 DEPOSITS 6955007 ADV. PREMIUMS AND DEPOSITS 27575088 RATE STABILIZATION RESERVE 2831261 DENTAL SERVICE CLAIMS RESERVES 12610348 BONUS ACCRUAL 420693 DEFERRED COMPENSATION 457B PLAN 1134815 51527212 811288730 4231848 4231848 807056882 297360 155200 452560 807509442 791309055 0 791309055 297360 155200 452560 791761615 PART XI, LINE 4B - OTHER ADJUSTMENTS: MISCELLANEOUS EXPENSES NOT NETTED AGAINST REVENUE 155,200. PART XII, LINE 4B - OTHER ADJUSTMENTS: MISCELLANEOUS EXPENSES NOT NETTED AGAINST REVENUE 155,200. 1 DELTA DENTAL OF VIRGINIA FOUNDATION 5415 AIRPORT ROAD ROANOKE VA 24012 453230862 2010694 0 FUNDING TO SUPPORT DELTA DENTAL FOUNDATION AND FURTHER ITS MISSION VIRGINIA HEALTH CATALYST 4200 INNSLAKE DR STE 202 GLEN ALLEN VA 23060 274082359 15000 0 ANNUAL SUMMIT SPONSORSHIP THE RESCUE MISSION PO BOX 11525 ROANOKE VA 24022 546001775 10000 0 2023 DRUMSTICK DASH SPONSORSHIP BOYS & GIRLS CLUBS OF SW VIRGINIA 1714 9TH ST SE ROANOKE VA 24013 541867366 55000 0 SPONSORSHIP PROAM KIDS GOLF TOURNAMENT BRADLEY FREE CLINIC 1240 3RD ST SW ROANOKE VA 24016 237380491 10000 0 BRADLEY FREE CLINIC 50TH ANNIVERSARY 5 PART I LINE 2: THE COMPANY HAS PROCEDURES TO ENSURE THAT ALL PROVIDED ASSISTANCE IS PROPERLY APPROVED BY MANAGEMENT. CONTRIBUTIONS TO THE DELTA DENTAL OF VIRGINIA FOUNDATION ARE APPROVED BY THE BOARD OF DIRECTORS. X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 MR FRANK L LUCIA PRESIDENT & CEO 0 849565 0 1170940 0 20813 0 66000 0 30859 0 2138177 0 0 MR DAVID NOTARI SENIOR VP & COO 511227 0 308000 0 10033 0 62154 0 29658 0 921072 0 0 0 MR R JAMES BARKER SECRETARY/TREASURER 0 425387 0 376400 0 2045 0 66000 0 17660 0 887492 0 0 MR BRADLEY KNOPF VICE PRESIDENT 272558 0 236104 0 2393 0 39586 0 23197 0 573838 0 0 0 MR CHRISTOPHER PYLE VICE PRESIDENT 314842 0 165624 0 614 0 40436 0 13877 0 535393 0 0 0 MS MELISSA KIRSH STAFF 297257 0 94107 0 2361 0 40656 0 28359 0 462740 0 0 0 MR MATTHEW MACDONALD STAFF 252045 0 85500 0 1034 0 40656 0 31068 0 410303 0 0 0 MR BRIAN KRAINER STAFF 160513 0 180873 0 1622 0 40656 0 25231 0 408895 0 0 0 MR JASON REYNOLDS STAFF 93002 0 167156 0 783 0 32338 0 11590 0 304869 0 0 0 MR JOHN WILSON STAFF 94287 0 154601 0 1633 0 30715 0 8992 0 290228 0 0 0 PART I, LINE 1A FIRST-CLASS OR CHARTER TRAVEL-WE FOLLOW ADOPTED POLICY FOR BOTH FIRST-CLASS OR CHARTER TRAVEL. IN SUMMARY, FIRST-CLASS TRAVEL IS NOT ALLOWED EXCEPT BY SPECIFIC GUIDANCE IN THE T & E POLICY (I.E. EXCEPTIONALLY LONG FLIGHT, ETC.) TRAVEL FOR COMPANIONS-WE FOLLOW ADOPTED CORPORATE TRAVEL AND ENTERTAINMENT (T&E) POLICY FOR COMPANIONS. IN SUMMARY, SPOUSAL TRAVEL IS NOT COVERED UNLESS SPECIFIC CRITERIA IS MET. PART I, LINE 4B THE PLANS WERE ESTABLISHED VIA THIS ORGANIZATION'S AND THE RELATED ORGANIZATION'S MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE'S COMPENSATION AND BENEFIT REVIEW WHICH IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THESE PLANS ARE IN ACCORDANCE WITH SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS AS PER IRS SECTIONS 409(A). THERE WERE NO LUMP SUM PAYMENTS PAID FROM THIS ORGANIZATION NOR A RELATED ORGANIZATION IN 2023. PART I, LINE 7 A PORTION OF EACH PERSON'S COMPENSATION IS AT RISK PROVIDING KEY METRICS AND GOALS ARE ACHIEVED. THE RESPECTIVE PROGRAMS FOR DISQUALIFIED PERSONS ARE SUBJECT TO THE MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE'S COMPENSATION AND BENEFIT REVIEW PROCESS WHICH IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 DELTA DENTAL OF VIRGINIA IS A NON-STOCK CORPORATION ORGANIZED UNDER TITLE 13.1 OF THE CODE OF VIRGINIA. CORVESTA, INC. IS THE SOLE MEMBER OF DDVA AS DEFINED IN SECTION 13.1-803 OF THE CODE OF VIRGINIA. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER VOTES ON QUESTIONS OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; AND AMENDING THE ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FULL DOCUMENT IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING. ALSO, MEMBERS OF THE BOARD OF DIRECTORS REVIEW THE PREPARATION PROCESS WITH SENIOR MEMBERS OF MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C DELTA DENTAL OF VIRGINIA REQUIRES CORPORATE OFFICERS AND EACH DIRECTOR ON THE BOARD OF DIRECTORS TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT THAT IS BASED ON IRS GUIDANCE. IN ADDITION, THE CONFLICT OF INTEREST POLICY REQUIRES DISCLOSURE OF ALL CONFLICTS, POTENTIAL CONFLICTS, OR ANY MATTER THAT MAY GIVE RISE TO THE APPEARANCE OF A CONFLICT. THE FORMS ARE REVIEWED BY THE COMPLIANCE OFFICER AND REPORTED TO THE CEO AND THE APPROPRIATE COMMITTEE(S) OF THE BOARD. THE FORMS ARE FURTHER AVAILABLE TO, AND REVIEWED BY, OUR AUDITORS AND THE BOI. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION ARRANGEMENTS FOR THE CEO AND OTHER DISQUALIFIED PERSONS ARE REVIEWED AND APPROVED BY THE MANAGEMENT DEVELOPMENT AND COMPENSATION COMMITTEE OF OUR BOARD OF DIRECTORS. THIS COMMITTEE CONSISTS ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE ANY CONFLICTS OF INTEREST AS TO THE ARRANGEMENTS BEING REVIEWED. THE COMMITTEE FOLLOWS THE PROCESSES OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THE COMMITTEE REVIEWS AND RELIES UPON COMPARABILITY DATA AND THE EXPERT RECOMMENDATIONS PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT. DELIBERATIONS AND DECISIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED. THIS PROCESS IS UNDERTAKEN AT LEAST ANNUALLY WITH RESPECT TO THE CEO AND ALL OTHER DISQUALIFIED PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE APPLICABLE FORMS ARE AVAILABLE FOR PUBLIC INSPECTION VIA REQUEST AND REGULATORY FILINGS. FORM 990, PART XI, LINE 9: SURPLUS TRANSFER TO HOLDING COMPANY -12,000,000. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO DELTA DENTAL OF VIRGINIA'S OVERSIGHT PROCESS OF THE AUDIT OR ITS SELECTION OF AN INDEPENDENT AUDITOR. CORVESTA INC 5415 AIRPORT ROAD ROANOKE VA 24012 205945158 HOLDING COMPANY VA 501(C)(4) N/A 0 DELTA DENTAL OF VIRGINIA FOUNDATION 5415 AIRPORT ROAD ROANOKE VA 24012 453230862 PROMOTION AND ADVANCEMENT OF ORAL HEALTH FOR THE PEOPLE OF VA VA 501(C)(3) LINE 12A, I DELTA DENTAL OF VIRGINIA 1 REVOLV INC 5415 AIRPORT ROAD ROANOKE VA 24012 271018474 PROVIDES TPA SERVICES TO DENTAL INSURANCE COMPANIES VA N/A C 0 STRYDEN INC 5415 AIRPORT ROAD ROANOKE VA 24012 352637734 PROVIDES VISION CARE INSURANCE VA N/A C 0 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 1 0 DELTA DENTAL OF VIRGINIA FOUNDATION B 2010694 FAIR MARKET VALUE