2022-11-11T07:00:59-06:00 2021-12-31 540504608 BROWN EDWARDS & COMPANY LLP 3906 ELECTRIC ROAD ROANOKE VA 24018 990 2021-01-01 453230862 DELTA DENTAL OF VIRGINIA FOUNDATION DELT 5409898000 4818 STARKEY ROAD ROANOKE VA 24018 FRANK L LUCIA PRESIDENT & CEO 5409898000 2022-11-08 1 FRANK LUCIA 999009999 PATRICK PITTMAN P00587461 5403450936 2022-11-08 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z FRANK L LUCIA 4818 STARKEY ROAD ROANOKE VA 24018 1102155 0 X WWW.DELTADENTALVA.COM/DDVAFOUNDATION.ASPX X 2011 VA IMPROVE THE PUBLIC'S ORAL HEALTH IN THE COMMONWEALTH OF VIRGINIA. 5 4 0 0 0 0 4543644 1102155 0 0 0 0 0 0 4543644 1102155 1222445 727100 0 0 20447 150451 0 0 0 3636467 232375 4879359 1109926 -335715 -7771 142123 1007043 125046 997737 17077 9306 THE FOUNDATION WORKS TO IMPROVE THE ORAL HEALTH OF ALL VIRGINIANS THROUGH FINANCIAL SUPPORT OF RESEARCH AND EDUCATION INITIATIVES AND PROGRAMS THAT PROVIDE ACCESS TO CARE FOR THE UNDERSERVED. 0 0 727100 727100 PROMOTION OF ORAL HEALTH CARE THROUGH EDUCATION, RESEARCH AND INCREASED ACCESS TO ORAL HEALTH CARE IN THE COMMONWEALTH OF VIRGINIA. 727100 1 1 0 0 0 0 0 0 0 0 0 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 0 0 0 1 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X RJAMES BARKER 5409898000 4818 STARKEY ROAD ROANOKE VA 24018 DR LEZLEY P MCILVEEN DIRECTOR 1.00 4.00 X 0 38423 0 DR A CAROLE PRATT DIRECTOR 1.00 3.00 X 0 28500 0 DR MCKINLEY L PRICE DIRECTOR 1.00 3.00 X 0 26250 0 MR JAN S SESSOR DIRECTOR 1.00 3.00 X 0 30000 0 MR FRANK L LUCIA PRESIDENT & CEO 1.00 41.00 X X 0 1165910 86606 0 1289083 86606 0 0 1 0 VIRGINIA HEALTH CATALYST 4200 INSLAKE DRIVE STE 202 GLEN ALLEN VA 23060 STRATEGIC PLANNING 138400 1 1002155 100000 1102155 1102155 0 0 0 X 727100 727100 150451 150451 207268 207268 22955 22955 872 872 BANK CHARGES 1280 1280 1109926 727100 382826 0 141657 904659 100000 466 2384 142123 1007043 125046 666100 0 331637 125046 997737 X 17077 9306 17077 9306 142123 1007043 -7771 0 X X 0 1 X 1 0 X X 1 DELTA DENTAL OF VIRGINIA 540844477 10 1 1002155 0 1 1002155 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, LINE 3B DELTA DENTAL OF VIRGINIA FOUNDATION ANNUALLY REQUESTS FROM DELTA DENTAL A PRO FORMA FORM 990 SCHEDULE A TO VERIFY IT MEETS THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR ITS MOST RECENT TAX YEAR. SCHEDULE A, PART IV, LINE 3C DELTA DENTAL OF VIRGINIA FOUNDATION HAS PROCEDURES IN PLACE TO ENSURE THAT ITS SUPPORT IS USED SOLELY FOR CHARITABLE PURPOSES. THE FOUNDATION MONITORS ALL GRANT MONIES AWARDED BY REQUIRING END-OF-YEAR UPDATES DETAILING HOW THE GRANT MONIES WERE USED. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO RELATED PARTIES 331637 331637 1102155 0 1102155 0 1102155 1109926 0 1109926 0 1109926 1 ARLINGTON FREE CLINIC 2921 11TH STREET S ARLINGTON VA 22204 541671883 IRC 501(C)(3) 75000 0 SUPPORT FREE HEALTHCARE SERVICES TO LOW-INCOME, MEDICALLY UNINSURED PATIENTS AUGUSTA REGIONAL DENTAL CLINIC 342 MULE ACADEMY RD FISHERSVILLE VA 22939 202922988 IRC 501(C)(3) 75000 0 EXPAND PATIENT CAPACITY & APPOINTMENT AVAILABILITY BRADLEY FREE CLINIC 1240 3RD ST SW ROANOKE VA 24016 237380491 IRC 501(C)(3) 50000 0 EXPAND PATIENT CAPACITY & APPOINTMENT AVAILABILITY CHIP OF ROANOKE VALLEY 1201 THIRD STREET SW ROANOKE VA 24016 541566451 IRC 501(C)(3) 85000 0 INTEGRATED DENTAL & MEDICAL CARE TO ENROLLED SPANISH SPEAKING FAMILIES EASTERN SHORE RURAL HEALTH SYSTEM INC 20280 MARKET STREET ONANCOCK VA 23417 510196935 IRC 501(C)(3) 50000 0 CAPITAL CONTRIBUTION FOR SCHOOL-BASED DENTAL PROGRAM FREE CLINIC OF CENTRAL VIRGINIA 1016 MAIN STREET LYNCHBURG VA 24504 541420756 IRC 501(C)(3) 100000 0 EXPAND ACCESS TO SAME-DAY OR NEXT-DAY DENTAL CARE GOOCHLANDCARES 2999 RIVER ROAD WEST GOOCHLAND VA 23063 541967650 IRC 501(C)(3) 91100 0 PROVIDE REIMBURSABLE DENTAL SERVICES TO ADULT MEDICAID RECIPIENTS MCV FOUNDATION 1228 EAST BROAD STREET RICHMOND VA 23298 546053660 IRC 501(C)(3) 10000 0 GEORGE LEVICKI SCHOLARSHIP FUND ROANOKE RESCUE MISSION 402 4TH STREET SE ROANOKE VA 24013 540573900 IRC 501(C)(3) 10000 0 COMMUNITY SHELTER WESTERN TIDEWATER FREE CLINIC 2019 MEADE PARKWAY SUFFOLK VA 23434 263302837 IRC 501(C)(3) 50000 0 EXPAND DENTAL SUITE FOR CAPACITY TO SERVE MORE PATIENTS FREEDOM FIRST ENTERPRISE 5240 VALLEYPARK DRIVE ROANOKE VA 24019 813904720 IRC 501(C)(3) 100500 0 FALLON PARK PROJECT FOR HEALTH & WELLNESS CLINIC 11 PART I, LINE 2: THE FOUNDATION REQUESTS A YEAR-END UPDATE OF HOW THE GRANT FUNDS WERE USED. 0 1 0 0 0 0 0 0 0 MR FRANK L LUCIA PRESIDENT & CEO 0 714478 0 433605 0 17827 0 58000 0 28606 0 1252516 0 0 PART I, LINE 1B NOT APPLICABLE 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 2021. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO THE ARTICLES OF INCORPORATION, THE FOUNDATION'S BOARD OF DIRECTORS ARE APPOINTED BY THE BOARD OF THE SUPPORTED ORGANIZATION, DELTA DENTAL OF VIRGINIA. 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 DOCUMENT AND PREPARATION PROCESS WITH SENIOR MEMBERS OF MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C DELTA DENTAL OF VIRGINIA FOUNDATION 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 C, LINE 19 THE APPLICABLE FORMS ARE AVAILABLE FOR PUBLIC INSPECTION VIA REQUEST AND REGULATORY FILINGS. FORM 990, PART IX, LINE 11G ADMINSTRATIVE OVERHEAD: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,948. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,948. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 200,320. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 200,320. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO DELTA DENTAL OF VIRGINIA FOUNDATION'S OVERSIGHT PROCESS OF THE AUDIT OR ITS SELECTION OF AN INDEPENDENT AUDITOR. DELTA DENTAL OF VIRGINIA 4818 STARKEY ROAD ROANOKE VA 24018 540844477 ADVANCE PUBLIC'S ORAL HEALTH BY PROVIDING QUALITY DENTAL BENEFITS. VA 501(C)(4) CORVESTA INC 0 CORVESTA INC 4818 STARKEY ROAD ROANOKE VA 24018 205945158 HOLDING COMPANY VA 501(C)(4) 0 REVOLV INC 4818 STARKEY ROAD ROANOKE VA 24018 271018474 PROVIDES TPA SERVICES TO DENTAL INSURANCE COMPANIES VA N/A C 0 STRYDEN INC 4818 STARKEY ROAD ROANOKE VA 24018 352637734 PROVIDES VISION CARE INSURANCE VA N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 DELTA DENTAL OF VIRGINIA C 1002155 DELTA DENTAL OF VIRGINIA P 324745 CORVESTA INC P 6892