2021-11-15T08:19:31-06:00 2020-12-31 540504608 BROWN EDWARDS & COMPANY LLP 319 MCCLANAHAN STREET SW ROANOKE VA 24014 990 2020-01-01 453230862 DELTA DENTAL OF VIRGINIA FOUNDATION DELT 5409898000 4818 STARKEY ROAD ROANOKE VA 24018 FRANK L LUCIA PRESIDENT & CEO 5409898000 2021-11-11 1 FRANK LUCIA 999009999 PATRICK PITTMAN P00587461 5403450936 2021-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z FRANK L LUCIA 4818 STARKEY ROAD ROANOKE VA 24018 4543644 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 420586 4543644 0 0 0 0 0 0 420586 4543644 409865 1222445 0 0 0 20447 0 0 0 42793 3636467 452658 4879359 -32072 -335715 352792 142123 0 125046 352792 17077 X 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. 1 0 4554508 1222445 PROMOTION OF ORAL HEALTH CARE THROUGH EDUCATION, RESEARCH AND INCREASED ACCESS TO ORAL HEALTH CARE IN THE COMMONWEALTH OF VIRGINIA. 4554508 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 0 0 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 3.00 X 0 29153 0 DR A CAROLE PRATT DIRECTOR 1.00 3.00 X 0 23600 0 DR MCKINLEY L PRICE DIRECTOR 1.00 3.00 X 0 23250 0 MR JAN S SESSOR DIRECTOR 1.00 3.00 X 0 23950 0 MR FRANK L LUCIA PRESIDENT & CEO 1.00 41.00 X X 0 1261140 84298 0 1361093 84298 0 0 1 0 VIRGINIA HEALTH CATALYST 4200 INSLAKE DRIVE STE 202 GLEN ALLEN VA 23060 STRATEGIC PLANNING 189000 1 4543644 4543644 4543644 0 0 0 1222445 1222445 20447 20447 196146 196146 108088 108088 COVID-19 RELIEF 3332063 3332063 DENTAL CLAIMS 170 170 4879359 4554508 324851 0 347224 141657 5568 466 352792 142123 0 125046 0 125046 X 352792 17077 352792 17077 352792 142123 -335715 0 X X 0 1 X 1 0 X X 1 DELTA DENTAL OF VIRGINIA 540844477 10 1 4543644 0 1 4543644 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 X 4543644 0 4543644 0 4543644 4879359 0 4879359 0 4879359 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 YEARS ENDED DECEMBER 31, 2020 AND 2019. 1 BLAND MINISTRY CENTER AND DENTAL CLINIC 65 SEDDON STREET BLAND VA 24315 541556134 IRC 501(C)(3) 100445 SCHOOL BASED DENTAL PROGRAM CHIP OF ROANOKE VALLEY 1201 THIRD STREET SW ROANOKE VA 24016 541566451 IRC 501(C)(3) 85000 DENTAL HOME REFERRALS THROUGH HOME VISITING PROGRAM COMMUNITY HEALTH CENTER OF NEW RIVER VALLEY 215 ROANOKE STREET CHRISTIANSBURG VA 24073 510247098 IRC 501(C)(3) 100000 SCHOOL BASED DENTAL PROGRAM CROSS-OVER MINISTRY INC 8600 QUIOCCASIN ROAD STE 101 RICHMOND VA 23229 541371067 IRC 501(C)(3) 100000 DENTAL SERVICES TO HIGH RISK PATIENTS EASTERN SHORE RURAL HEALTH SYSTEM INC 20280 MARKET STREET ONANCOCK VA 23417 510196935 IRC 501(C)(3) 92500 DENTAL HYGIENIST FOR EASTVILLE LUCY CORR FOUNDATION 6800 LUCY CORR BOULEVARD CHESTERFIELD VA 23832 542010957 IRC 501(C)(3) 22000 PLANNING FOR A DENTAL PROGAM TARGETING THE HISPANIC ELDERLY POPULATION BOYS & GIRLS CLUB OF SOUTHWEST VIRGINIA 1714 9TH STREET SE ROANOKE VA 24013 541867366 IRC 501(C)(3) 12500 JIM BARKER SCHOLARSHIP FUND MCV FOUNDATION 1228 EAST BROAD STREET RICHMOND VA 23298 546053660 IRC 501(C)(3) 10000 GEORGE LEVICKI SCHOLARSHIP FUND ARLINGTON FREE CLINIC 29210 11TH STREET S ARLINGTON VA 22204 541671883 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE AUGUSTA REGIONAL CLINIC 342 MULE ACADEMY RD FISHERSVILLE VA 22939 202922988 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE BLAND MINISTRY CENTER AND DENTAL CLINIC 8487 S SCENIC HWY BLAND VA 24315 541556134 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE BRADLEY FREE CLINIC 1240 3RD ST SW ROANOKE VA 24016 237380491 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE CHARLOTTESVILLE FREE CLINIC 1138 ROSE HILL DR 200 CHARLOTTESVILLE VA 22903 541610405 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE CHESAPEAKE CARE CLINIC 2145 S MILITARY HWY CHESAPEAKE VA 23320 541642754 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE CHRISTIAN FREE CLINIC IN BOTETOURT 7330 ROANOKE ROAD BOX 707 FINCASTLE VA 24090 204342697 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE COMMUNITY FREE CLINIC OF NEWPORT NEWS 757 25TH STREET NEWPORT NEWS VA 23607 273510814 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE CROSSOVER HEALTHCARE MINISTRY 8600 QUIOCCASIN RD STE 101 RICHMOND VA 23229 541371067 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE FAUQUIER FREE CLINIC 35 ROCK POINTE LN WARRENTON VA 20186 541669652 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE FREE CLINIC OF CENTRAL VIRGINIA 1016 MAIN STREET LYNCHBURG VA 24504 541420756 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE FREE CLINIC OF POWHATAN 3908 OLD BUCKINGHAM RD POWHATAN VA 23139 261275136 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE GLOUCESTER MATHEWS CARE CLINIC 6031 INDUSTRIAL DRIVE GLOUCESTER VA 23061 541875619 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE GOOCHLANDCARES 2999 RIVER ROAD WEST GOOCHLAND VA 23063 541967650 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE HANOVER INTERFAITH FREE CLINICS PO BOX 117 ASHLAND VA 23005 412214314 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE HEALING HANDS HEALTH CENTER 210 MEMORIAL DRIVE BRISTOL TN 37620 821987635 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE ST MARY'S HEALTH WAGON 5626 PATRIOT DRIVE WISE VA 24293 043739083 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE HELP MEDICAL AND DENTAL CLINIC 1320 LASALLE AVE HAMPTON VA 23669 541209213 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE OLIVET MEDICAL MINISTRIES INC DBA LACKEY CLINIC 1620 OLD WILLIAMSBURG ROAD YORKTOWN VA 23690 541850915 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE LLOYD F MOSS FREE CLINIC 1301 SAM PERRY BOULEVARD FREDERICKSBURG VA 22401 541677934 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE LUCY CORR FREE DENTAL CLINIC 6800 LUCY CORR BOULEVARD CHESTERFIELD VA 23832 542010957 IRC 501(C)(3) 14000 COVID-19 RELIEF/ASSISTANCE MEL LEAMAN FREE CLINIC 601 RADIO HILL RD MARION VA 24354 541993876 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE NORTHERN NECK-MIDDLESEX FREE HEALTH CLINIC 51 WILLIAM B GRAHAM COURT KILMARNOCK VA 22482 541679279 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE NORTHERN VIRGINIA DENTAL CLINIC 8221 WILLOW OAKS CORP DR STE 450 FAIRFAX VA 22031 541646071 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE PARK PLACE HEALTH AND DENTAL CLINIC 606 W 29TH STREET NORFOLK VA 23508 453086608 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE PIEDMONT REGIONAL DENTAL CLINIC 13296 JAMES MADISON HWY ORANGE VA 22960 270625764 IRC 501(C)(3) 22000 COVID-19 RELIEF/ASSISTANCE PRINCE WILLIAM AREA FREE CLINIC 13900 CHURCH HILL DRIVE WOODBRIDGE VA 22191 541619202 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE ST LUKE'S COMMUNITY CLINIC 316 N ROYAL AVE FRONT ROYAL VA 22630 810221486 IRC 501(C)(3) 10000 COVID-19 RELIEF/ASSISTANCE WESTERN TIDEWATER FREE CLINIC 2019 MEADE PARKWAY SUFFOLK VA 23434 263302837 IRC 501(C)(3) 18000 COVID-19 RELIEF/ASSISTANCE FREE CLINIC OF TWIN COUNTIES 140 LARKSPUR LANE GALAX VA 24333 541632194 IRC 501(C)(3) 4000 COVID-19 RELIEF/ASSISTANCE SHENANDOAH COUNTY FREE AND DENTAL CLINIC 124 VALLEY VISTA DRIVE WOODSTOCK VA 22664 542032008 IRC 501(C)(3) 20000 COVID-19 RELIEF/ASSISTANCE DENTAL CLINIC OF NORTHERN SHENANDOAH VALLEY 301 NORTH CAMERON STREET STE 200 WINCHESTER VA 22601 450573607 IRC 501(C)(3) 2000 COVID-19 RELIEF/ASSISTANCE UNITED WAY OF SOUTHWEST VA 1096 OLE BERRY DRIVE ABINGDON VA 24210 540718860 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE UNITED WAY OF ROANOKE VALLEY 325 CAMPBELL AVE SW ROANOKE VA 24016 540535302 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE ROANOKE RESCUE MISSION 402 4TH STREET SE ROANOKE VA 24013 540573900 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE FEEDING AMERICA SW VA 1025 ELECTRIC ROAD SALEM VA 24153 541939556 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE BOYS & GIRLS CLUB OF SW VA 1714 9TH STREET SE ROANOKE VA 24013 541867366 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE CHIP OF ROANOKE VALLEY 1201 THIRD STREET SW ROANOKE VA 24016 541566451 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE BOYS & GIRLS CLUB OF THE PENINSULA 11825 ROCK LANDING DRIVE NEWPORT NEWS VA 23606 941552134 IRC 501(C)(3) 25000 COVID-19 RELIEF/ASSISTANCE BOYS & GIRLS CLUB OF THE DANVILLE AREA 123 FOSTER ROAD DANVILLE VA 24541 541880308 IRC 501(C)(3) 12500 COVID-19 RELIEF/ASSISTANCE BOYS & GIRLS CLUB OF THE BLUE RIDGE 311 E CHURCH STREET STE B MARTINSVILLE VA 24112 263166453 IRC 501(C)(3) 12500 COVID-19 RELIEF/ASSISTANCE 49 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 712389 0 530823 0 17928 0 56000 0 28298 0 1345438 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 2020. FORM 990, PART III, LINE 2 AS A RESULT OF THE COVID-19 OUTBREAK, THE FOUNDATION ADDED ADDITIONAL PROGRAM SERVICES IN 2020 WHICH PROVIDED RELIEF TO DENTAL PRACTICES THAT WERE IMPACTED BY SHUTDOWNS, AS WELL AS ASSISTANCE WITH PERSONAL PROTECTIVE EQUIPMENT AND REOPENING EXPENSES INCURRED TO FACILITATE IMPROVING PATIENT ACCESS DURING THE BEGINNING OF THE PANDEMIC. TOTAL RELIEF PROVIDED IN 2020 WAS APPROXIMATELY $4,032,063. 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 MEMBERS OF THE BOARD OF DIRECTORS WILL REVIEW THE DOCUMENT AND THE REVIEW WILL BE DOCUMENTED AT THE SUBSEQUENT BOARD MEETING. 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 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 0 0 0 0 DELTA DENTAL OF VIRGINIA C 4543644