2017-11-13T14:32:29-06:00 2016-12-31 540504608 BROWN EDWARDS & COMPANY LLP 319 MCCLANAHAN STREET SW ROANOKE VA 24014 990 2016-01-01 205945158 CORVESTA INC CORV 5409898000 4818 STARKEY ROAD ROANOKE VA 240188542 R JAMES BARKER SECRETARY/TREASURER 5409898000 2017-11-13 1 M C WINGFIELD P00005971 5403450936 2017-11-13 206.248.228.130 2017-11-13 10:17:09 ES P 1C76154176221C93BBAE6EBFFF44143B5701FD35 638843A833DABD80BE41393BE01C4D6468F94E4B 2016 2017-02-10 21:41:12Z R JAMES BARKER 4818 STARKEY ROAD ROANOKE VA 240188542 5624273 0 X WWW.CORVESTA.COM X 2006 VA PROVIDE OPPORTUNITIES THROUGH A HOLDING COMPANY IN SUPPORT OF THE MISSION OF DELTA DENTAL OF VA. 13 12 143 0 0 0 0 0 0 0 -1114338 5624273 0 0 -1114338 5624273 0 0 0 0 17173454 18136135 0 0 0 5370581 2093055 22544035 20229190 -23658373 -14604917 32808205 41153132 4966427 13782554 27841778 27370578 GUIDING, MONITORING AND COORDINATING THE ACTIVITIES OF ITS SUBSIDIARY, DELTA DENTAL OF VIRGINIA ("DDVA") AND OTHER AFFILIATED ENTITIES, TO ACHIEVE THE TAX-EXEMPT HEALTH CARE PURPOSES OF DDVA IN AN EFFICIENT AND INTEGRATED MANNER. 0 0 GUIDING, MONITORING AND COORDINATING THE ACTIVITIES OF ITS SUBSIDIARY, DELTA DENTAL OF VIRGINIA ("DDVA") AND OTHER AFFILIATED ENTITIES, TO ACHIEVE THE TAX-EXEMPT HEALTH CARE PURPOSES OF DDVA IN AN EFFICIENT AND INTEGRATED MANNER. 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 46 0 1 143 1 0 1 IN 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X R JAMES BARKER 5409898000 4818 STARKEY ROAD ROANOKE VA 24018 MR THOMAS R BYRD CHAIRMAN OF THE BOARD 8.00 2.00 X X 33800 0 0 MR LYNDELL B BROOKS DIRECTOR 5.00 6.00 X 9800 24407 0 MR BARRY E DUVAL DIRECTOR 3.00 0.00 X 24850 0 0 MR MICHAEL L HOULISTON DIRECTOR 1.00 1.00 X 21750 661 0 DR MAYER G LEVY DIRECTOR 1.00 1.00 X 21400 700 0 DR EMANUEL W MICHAELS DIRECTOR 0.25 0.25 X 11350 387 0 DR ALBERT L PAYNE DIRECTOR 2.00 3.00 X 24550 3310 0 MS PAMELA S SCHUTZ DIRECTOR 4.00 0.00 X 28700 0 0 MR JAN S SESSOR DIRECTOR 4.00 0.00 X 23150 536 0 MR PATRICK N SHAFFNER DIRECTOR 4.00 5.00 X 26950 596 0 MS LAURA W THOMAS DIRECTOR 4.00 0.00 X 22800 0 0 MR STEVEN L TIMMONS DIRECTOR 4.00 0.00 X 28000 2385 0 DR GEORGE A LEVICKI PRESIDENT 40.00 2.00 X X 1077511 0 65456 MR R JAMES BARKER SECRETARY/TREASURER 40.00 0.00 X 387939 0 53462 MR CHAD MCINTOSH GENERAL COUNSEL 40.00 0.00 X 388290 0 52596 MS STACY CAMPBELL VICE PRESIDENT 40.00 0.00 X 369220 0 55332 MS SUSAN CAMPBELL VICE PRESIDENT 40.00 0.00 X 355305 0 44615 MS KATHARINE CLAYTOR VICE PRESIDENT 40.00 0.00 X 303017 0 50821 MR DAVID MITCHELL VICE PRESIDENT 40.00 0.00 X 327404 0 50120 MR MICAH ALMOND STAFF 40.00 0.00 X 257072 0 29528 MS DEBORAH MARTIN STAFF 40.00 0.00 X 179995 0 33578 MR MICHAEL PARRISH STAFF 40.00 0.00 X 165279 0 38028 MR DAVID DANCO STAFF 40.00 0.00 X 157390 0 39925 MS DAWN MCCRAY STAFF 40.00 0.00 X 152313 0 38505 MR MICHAEL W WISE FORMER SECRETARY/TREASURER 0.00 0.00 X 248744 0 0 4646579 32982 551966 35 1 1 0 HEALTHEDGE SOFTWARE INC 30 CORPORATE DRIVE BURLINGTON MA 01803 TECHNOLOGY SERVICES 1047806 DATACEDE SERVICES LLC 2 RESEARCH WAY 3RD FLR PRINCETON NJ 08540 TECHNOLOGY SERVICES 790372 NTT DATA INC 100 CITY SQUARE BOSTON MA 02129 IT CONSULTING 442927 SLAIT CONSULTING LLC 100 LANDMARK SQUARE VIRGINIA BEACH VA 23452 IT CONSULTING & SUPPORT 424050 TEK SYSTEMS INC PO BOX 198568 ATLANTA GA 303848568 IT STAFFING 142730 16 257468 257468 5366805 0 5366805 5366805 5366805 5624273 0 0 5624273 3858186 3858186 10446984 10446984 1238124 1238124 1695466 1695466 897375 897375 167604 167604 74568 74568 92703 92703 1264241 1264241 6007 6007 724964 724964 1075049 1075049 1333954 1333954 485633 485633 20934 20934 1180007 1180007 306559 306559 EQUIPMENT RENTAL & SOFT 755362 755362 TEMPORARY HELP 160818 160818 MISCELLANEOUS OPERATING 47509 47509 BUSINESS DUES 36928 36928 -5639785 -5639785 20229190 0 20229190 0 828573 1251342 126402 137032 578959 794055 15373430 7149822 3216138 8223608 15642616 15134965 12239486 14482848 176031 1129282 32808205 41153132 4921188 4704626 45239 6077928 3000000 4966427 13782554 X 0 0 0 0 27841778 27370578 27841778 27370578 32808205 41153132 X -14604917 -4475725 18609442 X 0 1 X 1 0 15373430 7149822 8223608 8223608 INVESTMENT IN CSSI 2143 C INVESTMENT IN CORVESTA LIFE 13368434 C INVESTMENT IN REVOLV 826471 C INVESTMENT IN ENCARA, INC 285800 C 14482848 X 680749341 675217770 675217770 5531571 92703 -1 92702 5624273 659759047 639622560 639622560 20136487 92703 92703 20229190 PART X, LINE 2: CORVESTA AND DELTA ARE EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF PUBLIC LAW 99-514, TAX REFORM ACT OF 1986, ACT SECTION 1012(C)(4)(C)(IV) AND HAVE RECEIVED FAVORABLE DETERMINATION LETTERS FROM THE IRS UNDER CODE SECTION 501(C)(4). THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3). INCOME TAXES ARE PROVIDED FOR THE TAX EFFECTS OF OMH'S, REVOLV'S, CSSI'S AND CORVESTA LIFE'S TRANSACTIONS REPORTED IN THE FINANCIAL STATEMENTS AND CONSIST OF TAXES CURRENTLY DUE OR REFUNDABLE, PLUS DEFERRED TAXES RELATED PRIMARILY TO NET OPERATING LOSSES AND THE DIFFERENCES BETWEEN THE TAX AND FINANCIAL REPORTING BASES OF PROPERTY AND EQUIPMENT AND STOCK-BASED COMPENSATION EXPENSE. THE DEFERRED TAXES REPRESENT THE FUTURE TAX RETURN CONSEQUENCES OF THOSE DIFFERENCES, WHICH WILL EITHER BE TAXABLE OR DEDUCTIBLE WHEN THE ASSETS AND LIABILITIES ARE RECOVERED OR SETTLED. BECAUSE OF THE NATURE OF CORVESTA'S BUSINESS, AND THAT OF ITS SUBSIDIARIES, AND AS A MATTER OF POLICY, MANAGEMENT BELIEVES THERE HAVE BEEN NO MATERIAL AGRESSIVE POSITIONS TAKEN IN THE ENTITY'S TAX AND INFORMATIONAL RETURN FILINGS FOR ANY REPORTING PERIODS OPEN TO NORMAL JURISDICTIONAL EXAMINATION, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. ACCORDINGLY, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS (OR ASSOCIATED PENALTIES AND INTEREST) IS PROVIDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: DELTA DENTAL OF VIRGINIA REVENUE 674,536,798. CORVESTA LIFE REVENUE 104,888. ELIMINATING ENTRY-REVOLV OTHER CLAIMS PROCESSING FEES PROVIDED DD -18,634,507. REVOLV REVENUE 19,353,706. INTERCOMPANY INCOME INCLUDED IN INVESTMENT INCOME -203,115. MANAGEMENT FEE FOR RELATED PARTY 60,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: ROUNDING -1. PART XII, LINE 2D - OTHER ADJUSTMENTS: DELTA DENTAL OF VIRGINIA EXPENSES 655,774,194. CORVESTA LIFE EXPENSES 1,102,581. BANK CHARGES -4,549. REVOLV EXPENSES 19,700,681. ELIMINATION OF RELATED FEES AND DEPRECIATION -17,048,701. ALLOCATED EXPENSES TO SUBS -19,961,646. MANAGEMENT FEE FOR RELATED PARTY 60,000. SOUTH ASIA - INDIA 1 0 PROVIDES SOFTWARE DEVELOPMENT, PROGRAMMING & PRODUCTION OF COMPUTER SOFTWARE N/A 106939 1 0 0 0 1 0 106939 0 106939 0 0 1 0 0 0 X X X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 DR GEORGE A LEVICKI PRESIDENT 570191 0 410992 0 96328 0 53000 0 12456 0 1142967 0 0 0 MR R JAMES BARKER SECRETARY/TREASURER 264654 0 122620 0 665 0 35000 0 18462 0 441401 0 0 0 MR CHAD MCINTOSH GENERAL COUNSEL 265559 0 121394 0 1337 0 33859 0 18737 0 440886 0 0 0 MS STACY CAMPBELL VICE PRESIDENT 247715 0 120168 0 1337 0 33859 0 21473 0 424552 0 0 0 MS SUSAN CAMPBELL VICE PRESIDENT 228185 0 125231 0 1889 0 33859 0 10756 0 399920 0 0 0 MS KATHARINE CLAYTOR VICE PRESIDENT 207508 0 94172 0 1337 0 33859 0 16962 0 353838 0 0 0 MR DAVID MITCHELL VICE PRESIDENT 222514 0 103001 0 1889 0 33859 0 16261 0 377524 0 0 0 MR MICAH ALMOND STAFF 188056 0 68471 0 545 0 28937 0 591 0 286600 0 0 0 MS DEBORAH MARTIN STAFF 147661 0 31477 0 857 0 23030 0 10548 0 213573 0 0 0 MR MICHAEL PARRISH STAFF 125055 0 39573 0 651 0 21066 0 16962 0 203307 0 0 0 MR DAVID DANCO STAFF 129845 0 26694 0 851 0 20432 0 19493 0 197315 0 0 0 MS DAWN MCCRAY STAFF 115649 0 36138 0 526 0 20231 0 18274 0 190818 0 0 0 MR MICHAEL W WISE FORMER SECRETARY/TREASURER 0 0 0 0 248744 0 0 0 0 0 248744 0 0 0 PART I, LINE 1A ALL ITEMS CHECKED ON LINE 1A FOLLOW THE POLICY GUIDELINES ADOPTED BY THE ORGANIZATION: 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 ARE MET. HEALTH OR SOCIAL CLUB DUES,IF ANY, ARE DETERMINED VIA THE COMPENSATION & BENEFITS REVIEW BY THE MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE OF THE BOARD. AS NOTED, THE EXECUTIVE COMPENSATION AND BENEFITS REVIEW IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. PART I, LINES 4A-B PART I, LINE 4A: MICHAEL WISE, FORMER VICE PRESIDENT OF FINANCE, WAS PAID $241,098 IN SEVERANCE IN 2016 PURSUANT TO HIS TERMINATION AGREEMENT APPROVED BY THE BOARD OF DIRECTORS. PART I, LINE 4B: THE FOLLOWING LUMP SUM PAYMENTS HAVE BEEN INCLUDED IN COLUMN B-III OF SCHEDULE J, PART II. THE LUMP SUM PAYMENTS IN 2016 WERE EARNED OVER A PRECEDING MULTI-YEAR PERIOD. THE PLAN WAS ESTABLISHED VIA THE MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE'S COMPENSATION AND BENEFIT REVIEW WHICH IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THE PLAN IS IN ACCORDANCE WITH SUPPLEMENTAL NONQUALIFIED DEFERRED COMPENSATION PLANS AS PER IRS SECTION 457(F). THE FOLLOWING AMOUNT WAS PAID IN 2016: EMPLOYEE AMOUNT DR. GEORGE A. LEVICKI $87,572 MICHAEL WISE, FORMER EMPLOYEE 7,646 PART I, LINE 7 A PORTION OF EACH PERSON'S COMPENSATION IS AT RISK PROVIDING KEY METRICS AND GOALS ARE ACHIEVED. THE RESPECTIVE PROGRAMS 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 B, LINE 11B MEMBERS OF THE BOARD OF DIRECTORS WILL REVIEW THE DOCUMENT WITH SENIOR MANAGEMENT MEMBERS. THE REVIEW WILL BE DOCUMENTED AT THE SUBSEQUENT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C CORVESTA, INC. 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. FORM 990, PART VI, SECTION B, LINE 15 THE CORVESTA, INC. BOARD HAS ORGANIZED A COMMITTEE, MANAGEMENT DEVELOPMENT & COMPENSATION COMMITTEE, CONSISTING OF OUTSIDE DIRECTORS. THE COMMITTEE FOLLOWS THE PROCESSES OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THE COMMITTEE MEETS 3 TO 4 TIMES PER YEAR. THE COMMITTEE ENGAGES OUTSIDE CONSULTANTS TO ASSIST IN ESTABLISHING COMPENSATION AND BENEFITS. THE OUTSIDE CONSULTANTS PROVIDE, AMONG OTHER ITEMS, COMPARABLE DATA (FORM 990 AND COMPENSATION STUDIES) OF PEER ORGANIZATIONS. THE COMMITTEE ADJUSTS COMPENSATION AND BENEFITS ACCORDINGLY BASED UPON THE ABOVE PROCESS RESULTS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON DEMAND. FORM 990, PART XI, LINE 9: REVOLV, INC. LOSS -346,978. ALLOCATED EXPENSES TO SUBS 20,021,646. WRITE-OFF OF OMH INVESTMENT -1,065,226. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO CORVESTA INC.'S OVERSITE PROCESS OF THE AUDIT OR ITS SELECTION OF AN INDEPENDENT AUDITOR. DELTA DENTAL OF VIRGINIA 4818 STARKEY ROAD ROANOKE VA 24018 540844477 PROVIDES DENTAL BENEFITS AND SERVICES VA 501(C)4 CORVESTA INC 1 DELTA DENTAL OF VIRGINIA FOUNDATION INC 4818 STARKEY ROAD ROANOKE VA 24018 453230862 PROMOTION AND ADVANCEMENT OF ORAL HEALTH FOR THE PEOPLE OF VA VA 501(C)3 LINE 12A, I DELTA DENTAL OF VIRGINIA 0 ONEMIND HEALTH (OMH) 4818 STARKEY ROAD ROANOKE VA 24018 204203105 PROVIDES DENTAL CLEARINGHOUSE SERVICES VA CORVESTA INC C -1491929 1 CORVESTA SOFTWARE SOLUTIONS PVT LTD 4818 STARKEY ROAD ROANOKE VA 24018 PROVIDES SOFTWARE DEVELOPMENT & PROGRAMMING IN CORVESTA INC C -121865 106939 0.99990 1 REVOLV INC 4818 STARKEY ROAD ROANOKE VA 24018 271018474 PROVIDES TPA SERVICES TO DENTAL INSURANCE COMPANIES VA CORVESTA INC C -346975 2980932 1.00000 1 CORVESTA LIFE INSURANCE COMPANY INC 4818 STARKEY ROAD ROANOKE VA 24018 860201136 PROVIDES LIFE INSURANCE AZ CORVESTA INC C -997693 10107321 1.00000 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 REVOLV INC B 650000 FAIR MARKET VALUE REVOLV INC Q 6357491 FAIR MARKET VALUE CORVESTA LIFE INSURANCE COMPANY B 600000 FAIR MARKET VALUE CORVESTA LIFE INSURANCE COMPANY Q 549644 FAIR MARKET VALUE DELTA DENTAL OF VIRGINIA K 252162 FAIR MARKET VALUE DELTA DENTAL OF VIRGINIA Q 8069072 FAIR MARKET VALUE DELTA DENTAL OF VIRGINIA Q 11063007 FAIR MARKET VALUE