2024-11-12T13:07:50-06:00 2023-12-31 540504608 BROWN EDWARDS & COMPANY LLP 3906 ELECTRIC ROAD ROANOKE VA 24018 990 2023-01-01 453230862 DELTA DENTAL OF VIRGINIA FOUNDATION DELT 5409898000 5415 AIRPORT ROAD ROANOKE VA 240121303 FRANK L LUCIA PRESIDENT & CEO 5409898000 2024-11-11 1 0 PATRICK PITTMAN P00587461 5403450936 2024-11-11 2023 2024-10-15 13:58:12Z X FRANK L LUCIA 5415 AIRPORT ROAD ROANOKE VA 240121303 2010694 0 X WWW.DELTADENTALVA.COM/FOUNDATION.HTML X 2011 VA IMPROVE THE PUBLIC'S ORAL HEALTH IN THE COMMONWEALTH OF VIRGINIA. 5 4 0 0 0 0 1955207 2010694 0 0 0 0 0 0 1955207 2010694 1491534 1637466 0 0 207885 0 0 0 0 239568 372680 1938987 2010146 16220 548 483913 1050886 458387 1024812 25526 26074 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 1658667 1637466 PROMOTION OF ORAL HEALTH CARE THROUGH EDUCATION, RESEARCH AND INCREASED ACCESS TO ORAL HEALTH CARE IN THE COMMONWEALTH OF VIRGINIA. 1658667 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 1 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 R JAMES BARKER 5409898000 5415 AIRPORT ROAD ROANOKE VA 24012 DR LEZLEY P MCILVEEN DIRECTOR 1.00 4.00 X 0 45045 0 DR A CAROLE PRATT DIRECTOR 1.00 3.00 X 0 35736 0 DR MCKINLEY L PRICE DIRECTOR 1.00 4.00 X 0 33375 0 MR JAN S SESSOR DIRECTOR 1.00 4.00 X 0 35625 0 MR FRANK L LUCIA PRESIDENT & CEO 1.00 41.00 X X 0 2041318 96859 0 2191099 96859 0 0 1 0 0 2010694 2010694 2010694 0 0 0 1637466 1637466 299836 299836 29766 21201 8565 5936 5936 13947 13947 11301 11301 11894 11894 2010146 1658667 351479 0 404853 972175 76603 75130 2457 3581 483913 1050886 445112 1014550 13275 10262 458387 1024812 X 25526 26074 25526 26074 483913 1050886 548 0 X X 0 1 X 1 0 X X 1 DELTA DENTAL OF VIRGINIA 540844477 10 1 2010694 0 1 2010694 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 OF VIRGINIA A PRO FORMA FORM 990 SCHEDULE A AND A COPY OF THE COMPANY'S SECTION 501(C)(4) DETERMINATION LETTER 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 10262 10262 2010694 0 2010694 0 2010694 2010146 0 2010146 0 2010146 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 BRADLEY FREE CLINIC 1240 3RD ST SW ROANOKE VA 24016 237380491 IRC 501(C)(3) 75000 0 EXPAND PATIENT CAPACITY & APPOINTMENT AVAILABILITY CHIP OF ROANOKE VALLEY 1201 THIRD STREET SW ROANOKE VA 24016 541566451 IRC 501(C)(3) 35000 0 INTEGRATED DENTAL & MEDICAL CARE TO ENROLLED SPANISH SPEAKING FAMILIES PIEDMONT REGIONAL DENTAL CLINIC 13296 JAMES MADISON HWY STE B ORANGE VA 22960 270625764 IRC 501(C)(3) 35000 0 ASSISTANCE TO SUPPORT 3D PRINTING SERVICES. ROANOKE RESCUE MISSION 402 4TH STREET SE ROANOKE VA 24013 540573900 IRC 501(C)(3) 30000 0 ASSISTANCE TO PROVIDE DENTAL SERVICES TO UNHOUSED PEOPLE. COMMONWEALTH OF VA STATE BOARD OF HEALTH 109 GOVERNOR STREET STE 717W RICHMOND VA 23219 546001775 IRC 501(C)(3) 267800 0 LOAN REPAYMENT PROGRAM FOR DENTISTS AND HYGENISTS. ROC SOLID FOUNDATION 5164 W MILITARY HWY STE 100 CHESAPEAKE VA 23321 264082283 IRC 501(C)(3) 7500 0 DONATION TO BUILD PLAYGROUND SETS. AUGUSTA REGIONAL DENTAL CLINIC 342 MULE ACADEMY ROAD FISHERSVILLE VA 22939 541651896 IRC 501(C)(3) 62000 0 ASSISTANCE TO SUPPORT RENOVATION OF OPERATION. FREE CLINIC OF POWHATAN 2320 SKAGGS ROAD POWHATAN VA 23139 261275136 IRC 501(C)(3) 60000 0 ASSISTANCE TO PROVIDE DENTAL SERVICES FOR UNINSURED AND MEDICAID PATIENTS. HAMPTON ECUMENICAL LODGING AND PROVISIONS INC 1320 LASALLE AVENUE HAMPTON VA 23669 541209213 IRC 501(C)(3) 100000 0 ASSISTANCE TO SUPPORT 3D PRINTING SERVICES FOR THREE CLINICS. HEALING HANDS HEALTH CENTER 245 MIDWAY MEDICAL PARK BRISTOL TN 37620 621677000 IRC 501(C)(3) 75000 0 ASSISTANCE TO PROVIDE DENTAL SERVICES TO UNINSURED AND MEDICAID PATIENTS. KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER 3716 MELROSE AVE NW ROANOKE VA 24017 541937835 IRC 501(C)(3) 75000 0 ASSISTANCE TO PROVIDE DENTAL SERVICES TO UNINSURED AND MEDICAID PATIENTS. GLOUCESTER MATHEWS CARE CLINIC PO BOX 684 GLOUCESTER VA 23061 541875619 IRC 501(C)(3) 7500 0 ASSISTANCE TO PROVIDE CAPACITY BUILDING FOR FREE CLINIC. HEART OF VIRGINIA FREE CLINIC PO BOX 142 FARMVILLE VA 23901 272785970 IRC 501(C)(3) 7500 0 ASSISTANCE TO PROVIDE CAPACITY BUILDING FOR FREE CLINIC. CARILION CLINIC PO BOX 12187 ROANOKE VA 24023 541190773 IRC 501(C)(3) 500000 0 ASSISTANCE PROVIDED FOR PEDIATRIC RESIDENCY SPECIAL OLYMPICS 3212 SKIPWITH RD SUITE 100 RICHMOND VA 23294 541013637 IRC 501(C)(3) 10000 0 SPONSORSHIP OF HEALTHY ATHLETES. AMERICAN NATIONAL RED CROSS & ITS CONSTITUENT CHAPTERS AND BRANCHES 430 17TH ST NW WASHINGTON DC 20006 530196605 IRC 501(C)(3) 10000 0 SUPPORT FOR DISASTER GIVING PROGRAM OLD DOMINION UNIVERSITY 4608 HAMPTON BLVD NORFOLK VA 23529 546000884 IRC 501(C)(3) 22125 0 SUPPORT FOR DENTAL HEALTH SUMMER BALLAD HEALTH FOUNDATION 1019 WEST OAKLAND AVENUE JOHNSON CITY TN 37604 581594191 IRC 501(C)(3) 10000 0 2023 SCHOLARSHIP SMYTH COUNTY AUGUSTA REGIONAL CLINIC 342 MULE ACADEMY ROAD FISHERSVILLE VA 22939 541651896 IRC 501(C)(3) 10826 0 ASSISTANCE TO SUPPORT CENTERS FOR INCLUSIVE DENTISTRY NEW YORK UNIVERSITY COLLEGE OF DENTISTRY 20280 MARKET ST ONANCOCK VA 23417 510196935 IRC 501(C)(3) 20000 0 ASSISTANCE TO SUPPORT CENTERS FOR INCLUSIVE DENTISTRY EASTERN SHORE RURAL HEALTH SYSTEMS INC 4200 INNSLAKE DRIVE GLEN ALLEN VA 23060 274082359 IRC 501(C)(3) 10582 0 ASSISTANCE TO SUPPORT CENTERS FOR INCLUSIVE DENTISTRY VIRGINIA HEALTH CATALYST 4200 INNSLAKE DRIVE GLEN ALLEN VA 23060 274082359 IRC 501(C)(3) 109000 0 SUPPORT FOR SCHOOL BASED ORAL HEALTH PROGRAM. PART I, LINE 2: THE FOUNDATION REQUESTS A YEAR-END UPDATE OF HOW THE GRANT FUNDS WERE USED. X 1 1 0 1 0 0 0 0 0 0 0 MR FRANK L LUCIA PRESIDENT & CEO 0 849565 0 1170940 0 20813 0 66000 0 30859 0 2138177 0 0 PART I, LINE 1B 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. 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 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 5415 AIRPORT ROAD ROANOKE VA 24012 540844477 ADVANCE PUBLIC'S ORAL HEALTH BY PROVIDING QUALITY DENTAL BENEFITS. VA 501(C)(4) CORVESTA INC 0 CORVESTA INC 5415 AIRPORT ROAD ROANOKE VA 24012 205945158 HOLDING COMPANY VA 501(C)(4) 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 DELTA DENTAL OF VIRGINIA C 2010694 FAIR MARKET VALUE CORVESTA INC P 311730 FAIR MARKET VALUE