2013-11-11T15:02:28-06:00
2012-12-31
540504608
BROWN EDWARDS & COMPANY LLP
319 MCCLANAHAN ST
ROANOKE
VA
24014
990
2012-01-01
453230862
DELTA DENTAL OF VIRGINIA FOUNDATION
DELT
5409898000
4818 STARKEY ROAD
ROANOKE
VA
24018
GEORGE A LEVICKI
PRESIDENT
5409898000
2013-11-07
1
M C WINGFIELD
P00005971
5403450936
2012
2016-03-07 17:11:31Z
GEORGE A LEVICKI
4818 STARKEY ROAD
ROANOKE
VA
24018
563370
0
X
WWW.DELTADENTALVA.COM/DDVAFOUNDATION.ASPX
X
2011
VA
IMPROVE THE PUBLIC'S ORAL HEALTH IN THE COMMONWEALTH OF VIRGINIA.
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1141829
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-578459
2500000
1926326
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1921541
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
1137000
1137000
PROMOTION OF ORAL HEALTH CARE THROUGH EDUCATION, RESEARCH AND INCREASED ACCESS TO ORAL HEALTH CARE IN THE COMMONWEALTH OF VIRGINIA.
1137000
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X
LYNDELL B BROOKS
5409898000
4818 STARKEY ROAD
ROANOKE
VA
24018
GEORGE A LEVICKI
PRESIDENT
1.00
41.00
X
X
0
1126648
60751
LYNDELL B BROOKS
TREASURER
1.00
5.00
X
X
0
26466
0
DR BARRY WOLFE
SECRETARY
1.00
3.00
X
X
0
21466
0
0
1174580
60751
0
0
1
0
0
563348
563348
22
22
563370
0
0
22
1137000
1137000
2600
2600
PUBLIC RELATIONS
2185
2185
BANK CHARGES
44
44
1141829
1137000
4829
0
2500000
1926326
2500000
1926326
4785
0
4785
X
0
0
0
0
2500000
1921541
2500000
1921541
2500000
1926326
-578459
0
X
0
1
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0
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0
0
DELTA DENTAL OF VIRGINIA
540844477
501(C)(4)
1
1
1
1137000
1
1137000
RESTRICTED
RESTRICTED
RESTRICTED
RESTRICTED
RESTRICTED
RESTRICTED
RESTRICTED
RESTRICTED
0
X
563370
0
563370
0
563370
1141829
0
1141829
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1141829
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
PART X, LINE 2:
THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR THE YEAR ENDED DECEMBER 31, 2012 OR THE PERIOD FROM MARCH 29, 2011 TO DECEMBER 31, 2011. THE FEDERAL INFOMRATIONAL RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED.
1
BOYS & GIRLS CLUBS OF SOUTHWEST VA
1714 9TH STREET SE
ROANOKE
VA
24013
541867366
501(C)(3)
20000
SMART SMILES AT THE DENTIST PROGRAM
BRADLEY FREE CLINIC OF ROANOKE VALLEY INC
1240 THIRD STREET SW
ROANOKE
VA
24016
237380491
501(C)(3)
10000
FREE DENTAL CARE TO THE UNINSURED AND LOW INCOME ADULTS
CHILD HEALTH INVESTMENT PARTNERSHIP
1201 THIRD STREET SW
ROANOKE
VA
24016
541566451
501(C)(3)
10000
FLORIDE VARNISH TREATMENTS
COMMUNITY FREE CLINIC OF NEWPORT NEWS
727 25TH STREET
NEWPORT NEWS
VA
23607
273510814
501(C)(3)
10000
STAFFING OF THE CLINIC'S DENTAL PROGRAM
COUNCIL OF COMMUNITY SERVICES
502 CAMPBELL AVENUE
ROANOKE
VA
24016
540718859
501(C)(3)
20000
ROANOKE MOM (MISSION OF MERCY) PROJECT
CRAIG COUNTY RURAL HEALTH CARE CORPORATION
226 MARKET STREET PO BOX 370
NEW CASTLE
VA
24127
562569389
501(C)(3)
10000
SCHOOL BASED DENTAL PROGRAM, SCHOOL BASED SEALANTS
EASTERN SHORE RURAL HEALTH SYSTEM INC
9434 HOSPITAL AVENUE PO BOX 1039
NASSAWADOX
VA
23413
510196935
501(C)(3)
15000
PURCHASE INTRA-ORAL DIGITAL X-RAY & PROCESSOR FOR NEW DENTAL WINKG AT HEALTH CENTER
GLOUCHESTER-MATHEWS FREE CLINIC
7314 MAIN STREET PO BOX 684
GLOUCESTER
VA
23061
541875619
501(C)(3)
35000
ASSIST IN BUILDING OUT 3 OPERATORY DENTAL CLINICS
GOOCHLAND FREE CLINIC & FAMILY SERVICES
1800 SANDY HOOK ROAD
GOOCHLAND
VA
23063
541967650
501(C)(3)
10000
EXPAND DENTAL SERVICES
HORIZON HEATH SERVICES INC
8579 IVOR ROAD
IVOR
VA
23866
541103176
501(C)(3)
10000
SUBSIDIZE THE DENTIST'S SALARY
NORTHERN VIRGINIA DENTAL CLINIC INC
5827 COLUMBIA PIKE STE 405
FALLS CHURCH
VA
22041
541646071
501(C)(3)
10000
ORAL HEALTH CARE SERVICES TO UNINSURED AND UNDERSERVED ADULTS
OLIVET MEDICAL MINISTRY INC DBA LACKEY FREE CLINIC
1620 OLD WILLIAMSBURG ROAD
YORKTOWN
VA
23690
541850915
501(C)(3)
10000
DENTAL EQUIPMENT FOR CLINIC EXPANSION
PARK PLACE HEALTH & DENTAL CLINIC INC
606 W 29TH STREET
NORFOLK
VA
23508
453086608
501(C)(3)
10000
SUPPORT FOR VCU DENTAL STUDENTS & HYGIENISTS WORKING AT THE DENTAL CLINIC
PIEDMONT ACCESS TO HEALTH SERVICES INC
705 MAIN STREET
DANVILLE
VA
24541
542026502
501(C)(3)
10000
PROVIDE DENTAL CARE TO INSURED AND UNINSURED PATIENTS
PIEDMONT REGIONAL DENTAL CLINIC INC
13296 JAMES MADISON HWY STE B
ORANGE
VA
22960
270625764
501(C)(3)
10000
EQUIPMENT & SUPPLIES FOR CLINIC AND MOBILE DENTAL UNIT THAT SERVICES SCHOOLS
PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION
407 STARLING AVENUE
MARTINSVILLE
VA
24112
201468244
501(C)(3)
10000
COVER EXPENSES RELATED TO DENTAL & DENTAL HYGIENE STUDENTS COMING TO CLINIC
RESCUE MISSION OF ROANOKE INC
402 4TH STREET SE
ROANOKE
VA
24013
540573900
501(C)(3)
35000
EXPAND DENTAL TREATMENT SERVICES
ROCKBRIDGE AREA FREE CLINIC
25 NORTHRIDGE LANE
LEXINGTON
VA
24450
541642220
501(C)(3)
25000
STAFFING FOR NEW CLINIC
SCIENCE MUSEUM OF WESTERN VIRGINIA
4412 ELECTRIC ROAD
ROANOKE
VA
24018
541023953
501(C)(3)
8000
"BIGMOUTH" UPGRADE & CREATION OF "LITTLE BIGMOUTH"
SHENANDOAH DENTAL CLINIC
781 SPRING PARKWAY
WOODSTOCK
VA
22664
680657235
501(C)(3)
20000
EQUIPMENT TO EXPAND DENTAL SERVICES
VCU SCHOOL OF DENTISTRY
PO BOX 980566
RICHMOND
VA
23298
546001758
125000
SCHOLARSHIP FUNDS FOR DENTAL SCHOOL
VIRGINIA DENTAL ASSOCIATION FOUNDATION
3460 MAYLAND COURT STE 110
RICHMOND
VA
23298
541821602
501(C)(3)
35000
MOM (MISSION OF MERCY) PROJECTS
VIRGINIA HEALTH CARE FOUNDATION
707 EAST MAIN STREET STE 1350
RICHMOND
VA
23219
541639924
501(C)(3)
374000
ESTABLISH NEW DENTAL SAFETY NET ORGANIZATIONS & MONIES FOR DENTAL OPPORTUNITES CHAMPION
VIRGINIA TECH CARILION SCHOOL OF MEDICINE INC
TWO RIVERSIDE CIRCLE
ROANOKE
VA
24016
264556177
501(C)(3)
250000
PERMANENTLY ENDOW THE DELTA DENTAL ORAL HEALTH TEACHING CURRICULUM
23
1
PROCEDURE FOR MONITORING GRANTS IN THE U.S.:
PART I, LINE 2:
SCHEDULE I, PART I, LINE 2: THE FOUNDATION REQUESTS A MID-YEAR AND YEAR-END UPDATE OF HOW THE GRANT FUNDS WERE USED.
0
1
0
0
0
0
0
0
0
GEORGE A LEVICKI
PRESIDENT
0
484443
0
637081
0
5124
0
49000
0
11751
0
1187399
0
0
PART I, LINE 1B
NOT APPLICABLE
PART I, LINE 4B
PART I, LINE 4B: SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN - IF ANY, THESE AMOUNTS ARE DETERNMINED VIA 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. THE FOLLOWING AMOUNT IS INCLUDED IN COLUMN B-II OF SCHEDULE J PART III: GEORGE LEVICKI $0
FORM 990, PART VI, SECTION A, LINE 2
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 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 11
MEMBERS OF THE BOARD OF DIRECTORS WILL REVIEW THE DOCUMENT AND THE REVIEW WILL BE DOCUMENTED AT THE BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD OF DIRECTORS COMPLETE CONFLICT OF INTEREST FORMS ANNUALLY. ALL ARE FILED IN THE CORPORATE MINUTE BOOK WHICH IS REVIEWED BY OUR AUDITORS.
FORM 990, PART VI, SECTION C, LINE 19
THE APPLICABLE FORMS ARE AVAILABLE FOR PUBLIC INSPECTION VIA REQUEST AND REGULATORY FILINGS.
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
MERCURY DATA EXCHANGE INC
4818 STARKEY ROAD
ROANOKE
VA
24018
204203105
PROVIDES CLEARINGHOUSE SERVICES TO DENTAL OFFICES
VA
N/A
C
0
CORVESTA SOFTWARE SOLUTIONS PVT LTD
4818 STARKEY ROAD
ROANOKE
VA
24018
PROVIDES SOFTWARD DEVELOPMENT, PROGRAMMING & PRODUCTION OF COMPUTER SOFTWARE
IN
N/A
C
0
CORVESTA SERVICES INC
4818 STARKEY ROAD
ROANOKE
VA
24018
271018474
PROVIDES VALUE-ADDED SERVICES PRIMARILY RELATED TO DENTAL INSURANCE
VA
N/A
C
0
CORVESTA LIFE INSURANCE COMPANY INC
4818 STARKEY ROAD
ROANOKE
VA
24018
860201136
PROVIDES LIFE INSURANCE POLICIES
AZ
N/A
C
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
DELTA DENTAL OF VIRGINIA
C
563348
FAIR MARKET VALUE