2014-11-12T08:03:23-06:00 2013-12-31 540504608 BROWN EDWARDS & COMPANY LLP 319 MCCLANAHAN ST ROANOKE VA 24014 990 2013-01-01 205945158 CORVESTA INC CORV 5409898000 4818 STARKEY ROAD ROANOKE VA 240188542 MICHEAL W WISE SECRETARY/TREASURER 5409898000 2014-11-12 1 M C WINGFIELD P00005971 5403450936 2013 2015-11-30 17:44:51Z MICHAEL W WISE 4818 STARKEY ROAD ROANOKE VA 240188542 59757 0 X N/A X 2006 VA PROVIDE OPPORTUNITIES THROUGH A HOLDING COMPANY IN SUPPORT OF THE MISSION OF DELTA DENTAL OF VA. 13 12 110 0 0 0 0 0 30586 0 -4508070 -4802636 0 0 -4477484 -4802636 0 0 0 0 11228415 12119184 0 0 0 4989875 5824037 16218290 17943221 -20695774 -22745857 47759067 41215846 4349803 4108381 43409264 37107465 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 1 1 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 0 0 1 46 0 1 110 1 0 1 IN 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 0 X MICHAEL W WISE 5409898000 4818 STARKEY ROAD ROANOKE VA 24018 DR GEORGE A LEVICKI PRESIDENT 40.00 2.00 X X 2448406 0 73071 MR LYNDELL B BROOKS DIRECTOR 5.00 5.00 X 23700 7526 0 MR THOMAS R BYRD DIRECTOR 3.00 X 18000 0 0 MR GORDON L GENTRY JR DIRECTOR 5.00 4.00 X 12000 17882 0 MICHAEL L HOULISTON PC DIRECTOR 1.00 2.00 X 23850 6206 0 MR JESS NEWBERN III DIRECTOR 5.00 4.00 X 26650 2927 0 MR PATRICK N SHAFFNER CHAIRMAN OF THE BOARD 5.00 4.00 X X 31250 418 0 DR ALBERT PAYNE DIRECTOR 1.00 2.00 X 28000 1188 0 MR BARRY DUVAL DIRECTOR 2.00 X 21400 0 0 DR MAYER G LEVY DIRECTOR 1.00 1.00 X 20700 700 0 DR EMANUEL W MICHAELS DIRECTOR 1.00 2.00 X 21050 1540 0 MS PAMELA SCHUTZ DIRECTOR 4.00 X 29750 0 0 MR STEVE TIMMONS DIRECTOR 3.00 X 23350 1480 0 MICHAEL W WISE SECRETARY/TREASURER 40.00 X 943135 0 62785 KATHARINE CLAYTOR VICE PRESIDENT 40.00 X 196564 0 36856 STACY CAMPBELL VICE PRESIDENT 40.00 X 264026 0 48860 R JAMES BARKER VICE PRESIDENT 40.00 X 210951 0 38117 SUSAN CAMPBELL VICE PRESIDENT 40.00 X 191151 0 8758 BARBARA BURTON STAFF 40.00 X 182759 0 28890 BRUCE JOHNSON STAFF 40.00 X 181154 0 39557 V DEAN RODIL STAFF 40.00 X 173653 0 38683 CHAD MCINTOSH STAFF 40.00 X 275415 0 36905 DINESH MAKKED STAFF 32.00 X 174830 0 16059 5521744 39867 428541 24 0 1 0 ROBERT E NOLAN COMPANY 92 HOPMEADOW STREET WEATOGUE CT 06089 BUSINESS MANAGEMENT CONSULTAND 689335 CDW DIRECT LLC PO BOX 75723 CHICAGO IL 60675 TECHNOLOGY SERVICES 313065 POPULUS GROUP LLC 850 STEPHENSON HWY SUITE 500 TROY MI 48083 HUMAN RESOURCES 145657 THOMAS E MARTENSTEIN 8001 FRANKLINK FARMS DRIVE STE 242 RICHMOND VA 23229 LEGAL SERVICES 131895 4 59757 59757 4862393 -4862393 -4862393 -4862393 -4802636 0 0 -4802636 X 4802379 4802379 4880422 4880422 725252 725252 1042520 1042520 668611 668611 331719 331719 55200 55200 13206 13206 1797434 1797434 26941 26941 643668 643668 1078321 1078321 1089229 1089229 297801 297801 1651081 1651081 128249 128249 EQUIPMENT RENTAL & SOFT 1431030 1431030 TEMPORARY HELP 252754 252754 BUSINESS DUES 30441 30441 DATA PROCESSING COSTS 27421 27421 -3030458 -3030458 17943221 0 17943221 0 1472605 3696145 315764 283505 381237 534621 7057492 3549652 2243296 3507840 4430833 4471980 29184191 24365693 9731141 4356062 47759067 41215846 1864863 2365675 2484940 1525197 0 217509 4349803 4108381 X 0 0 0 0 43409264 37107465 43409264 37107465 47759067 41215846 X -22745857 16444058 X X 0 1 X 1 0 7057492 3549652 3507840 3507840 INVESTMENT IN ONEMIND HEALTH, INC. 2513293 C INVESTMENT IN HEALTHENTIC 197995 C INVESTMENT IN CSSI 2143 C INVESTMENT IN C3 JIAN 7849569 C INVESTMENT IN REVOLV, INC. 3215301 C INVESTMENT IN CORVESTA LIFE 10368434 C INVESTMENT IN ENCARA 218958 C 24365693 DUE FROM REVOLV, INC. 3952508 DUE FROM CSSI 396737 DUE FROM CORVESTA LIFE 6817 4356062 DUE TO DDVA 217509 217509 X 592169221 596971857 596971857 -4802636 0 -4802636 595794690 577865870 577865870 17928820 14401 14401 17943221 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 LETTER 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 ONEMIND HEALTH'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 START UP COSTS. 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 (CURRENTLY 2010, 2011, AND 2012). ACCORDINGLY, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS (OR ASSOCIATED PENALTIES AND INTEREST) IS PROVIDED. AS PART OF THE CURRENT YEAR ACQUISITION OF CORVESTA LIFE IN 2011, ANY LIABILITIES THAT ARISE AS PART OF ANY EXAMINATIONS FOR YEARS PRIOR TO THE ACQUITION ARE NOT THE LIABILITY OF CORVESTA, BUT ARE THE RESPONSIBILITY OF THE FORMER OWNERS. PART XI, LINE 2D - OTHER ADJUSTMENTS: DELTA DENTAL OF VIRGINIA REVENUE 596,264,854. ONEMIND HEALTH REVENUE 931,862. ELIMINATING ENTRY FOR INTERCOMPANY SERVICE FEES CHARGED BETWEEN OMH AND DDVA -175,848. CORVESTA LIFE REVENUE 83,994. ELIMINATING ENTRY-REVOLV OTHER CLAIMS PROCESSING FEES PROVIDED DD -15,900,731. REVOLV REVENUE 16,325,620. RECLASSIFY CSSI REVENUE AS INTERNAL RECOVERY/CAPITALIZATION OF PAYROLL COSTS -723,903. CSSI REVENUE 723,903. BANK CHARGES -14,401. INTERCOMPANY INCOME INCLUDED IN INVESTMENT INCOME -574,693. MANAGEMENT FEE FOR RELATED PARTY 31,200. PART XII, LINE 2D - OTHER ADJUSTMENTS: DELTA DENTAL OF VIRGINIA EXPENSES 585,372,785. ONEMIND HEALTH EXPENSES 6,933,118. CORVESTA LIFE EXPENSES 656,862. CSSI EXPENSES 568,268. REVOLV EXPENSES 17,977,900. ELIMINATION OF RELATED FEES AND DEPRECIATION -17,501,509. ALLOCATED EXENSES TO SUBS -16,097,593. ELIMINATION OF CSSI INCOME TAXES -75,161. MANAGEMENT FEE FOR RELATED PARTY 31,200. PART XII, LINE 4B - OTHER ADJUSTMENTS: BANK CHARGES 14,401. SOUTH ASIA 1 30 PROVIDES SOFTWARE DEVELOPMENT, PROGRAMMING & PRODUCTION OF COMPUTER SOFTWARE N/A 838018 1 30 0 0 1 30 838018 0 838018 0 0 1 0 0 0 X X X 1 1 X X X X X X 0 1 0 0 0 0 0 1 1 1 DR GEORGE A LEVICKI PRESIDENT 508656 0 132456 0 1807294 0 50000 0 23071 0 2521477 0 0 0 MICHAEL W WISE SECRETARY/TREASURER 315460 0 26091 0 601584 0 50000 0 12785 0 1005920 0 0 0 KATHARINE CLAYTOR VICE PRESIDENT 144585 0 51105 0 874 0 19910 0 16946 0 233420 0 0 0 STACY CAMPBELL VICE PRESIDENT 200460 0 62676 0 890 0 31850 0 17010 0 312886 0 0 0 R JAMES BARKER VICE PRESIDENT 154477 0 55691 0 783 0 21119 0 16998 0 249068 0 0 0 SUSAN CAMPBELL VICE PRESIDENT 160719 0 29167 0 1265 0 0 0 8758 0 199909 0 0 0 BARBARA BURTON STAFF 147971 0 29844 0 4944 0 22157 0 6733 0 211649 0 0 0 BRUCE JOHNSON STAFF 145245 0 34234 0 1675 0 22547 0 17010 0 220711 0 0 0 V DEAN RODIL STAFF 133594 0 39278 0 781 0 21709 0 16974 0 212336 0 0 0 CHAD MCINTOSH STAFF 207757 0 66768 0 890 0 19895 0 17010 0 312320 0 0 0 DINESH MAKKED STAFF 156079 0 18320 0 431 0 1959 0 14100 0 190889 0 0 0 PART I, LINE 1A ALL ITEMS CHECKED ON LINE 1A FOLLOW THE POLICY GUIDELINE SET FORTH BY DELTA DENTAL OF VIRGINIA: 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, THESE ARE DETERMINED VIA THE COMPENSATION & BENEFITS REVIEW BY THE EXECUTIVE 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, LINE 4B THE FOLLOWING LUMP SUM PAYMENTS HAVE BEEN INCLUDED IN COLUMN B-III OF SCHEDULE J, PART II. THE LUMP SUM PAYMENTS IN 2013 WERE EARNED OVER A PRECEDING MULTI-YEAR PERIOD. THE PLAN WAS ESTABLISHED VIA THE EXECUTIVE 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 409(A). THE FOLLOWING WERE AMOUNTS PAID IN 2013: EMPLOYEE AMOUNT GEORGE A. LEVICKI $1,800,000 MICHAEL W. WISE $600,000 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 EXECUTIVE COMPENSATION COMMITTEE'S COMPENSATION AND BENEFIT REVIEW PROCESS WHICH IS IN ACCORDANCE WITH THE PROCESS OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. PART I, LINE 8 ANY AMOUNTS SUBJECT TO SUCH REQUIREMENTS WERE REVIEWED IN CONJUNCTION WITH THE EXECUTIVE COMPENSATION COMMITTEE'S COMPENSATION AND BENEFITS REVIEW PROCESS. COMPENSATION ACCRUED UNDER THIS PLAN DURING 2013 WAS $0. FORM 990, PART VI, SECTION B, LINE 11 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 YES. 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, EXECUTIVE COMPENSATION COMMITTEE, CONSISTING OF OUTSIDE DIRECTORS. THE EXECUTIVE COMMITTEE FOLLOWS THE PROCESSES OUTLINED BY THE IRS FOR SETTING REASONABLE COMPENSATION. THE EXECUTIVE COMPENSATION COMMITTEE MEETS 3 TO 4 TIMES PER YEAR. THE EXECUTIVE COMPENSATION COMMITTEE ENGAGES OUTSIDE CONSULTANTS TO ASSIST IN ESTABLISHING COMPENSATION AND BENEFIT. THE OUTSIDE CONSULTANTS PROVIDE, AMONG OTHER ITEMS, COMPARABLE DATA (FORM 990 AND COMPENSATION STUDIES) OF PEER ORGANIZATIONS. THE EXECUTIVE 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 IX, LINE 11G PROFESSIONAL SERVICES & FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,797,434. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,797,434. FORM 990, PART XI, LINE 9: SURPLUS TRANSFER 8,000,000. REVOLV, INC. LOSS -1,652,279. ALLOCATED EXENSES TO SUBS 16,097,593. ONEMIND HEALTH, INC. LOSS -6,001,256. 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 0 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 11A, I DELTA DENTAL OF VIRGINIA 0 ONEMIND HEALTH (OMH) 4818 STARKEY ROAD ROANOKE VA 24018 204203105 PROVIDES CLEARING- HOUSE SERVICES TO DENTAL OFFICES NATIONWIDE VA CORVESTA INC C -6001256 3346624 1.00000 0 CORVESTA SOFTWARE SOLUTIONS PVT LTD 4818 STARKEY ROAD ROANOKE VA 24018 PROVIDES SOFTWARE DEVELOPMENT, PROGRAMMING & PRODUCTION OF COMPUTER SOFTWARE IN CORVESTA INC C 119786 838018 0.99990 0 REVOLV INC 4818 STARKEY ROAD ROANOKE VA 24018 271018474 PROVIDES TPA SERVICES TO DENTAL INSURANCE COMPANIES VA CORVESTA INC C -1652280 8410477 1.00000 0 CORVESTA LIFE INSURANCE COMPANY INC 4818 STARKEY ROAD ROANOKE VA 24018 860201136 PROVIDES LIFE INSURANCE AZ CORVESTA INC C -572868 10105133 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 DELTA DENTAL OF VIRGINIA S 8000000 FAIR MARKET VALUE REVOLV INC R 3952508 FAIR MARKET VALUE DELTA DENTAL OF VIRGINIA N 434814 FAIR MARKET VALUE CORVESTA SOFTWARE SOLUTIONS PVT LTD R 320612 FAIR MARKET VALUE DELTA DENTAL OF VIRGINIA Q 14597303 FAIR MARKET VALUE ONEMIND HEALTH (OMH) B 6228282 FAIR MARKET VALUE ONEMIND HEALTH (OMH) Q 349534 FAIR MARKET VALUE REVOLV INC Q 4638513 FAIR MARKET VALUE CORVESTA LIFE INSURANCE COMPANY INC Q 81898 FAIR MARKET VALUE